Date: ..............
(date on which notice is sent or remitted)
..............
(name of merchant)
.............. ..............
(telephone number of merchant)
..............
(address of merchant)
hereinafter called the merchant notifies
..............
(name of consumer)
..............
..............
(address of consumer)
hereinafter called the consumer,
that he is in default to perform his obligation in accordance with the contract
(No. ..............) made between them
(number of the contract if indicated)
at .............. on .............. and that the
(place where the contract was made) (date when the contract was made)
following payment(s) is(are) due:
$.............. on ..............
(amount of payment) (date on which the payment is due)
$.............. on ..............
(amount of payment) (date on which the payment is due)
for a total amount of $ .............. at this date.
(amount due)
Consequently, if the consumer does not remedy his default by paying the amount due within 30 days of receiving this notice, the total amount of payments due and future instalments, in the amount of $ .............., shall become payable at that time.
The consumer may, however, by motion, petition the court to change the terms and conditions of payment or to be authorized to return the goods leased to the merchant. In that case, return of the goods authorized by the court entails the extinguishment of the obligation and the merchant is not required to return the amount of instalments he has received.
Such motion must be served and filed in the office of the court within 30 days after the consumer receives this notice.
Furthermore, the consumer may also, without the authorization of the court, return the goods to the merchant and thus rescind his contract. In such case, the merchant is not bound to return the amount of the payments due he has already received, and he cannot claim any damages other than those actually resulting, directly and immediately, from the rescission of the contract.
The consumer is advised to examine his contract and, if further information is necessary, to contact the Office de la protection du consommateur.
..............
(name of the merchant)
..............
(signature of the merchant)