Waiver Application Letter

You can use this Waiver Application Letter to request a party entitled to payment to forego any restrictions they might be holding against you.

[Applicant’s Name]

[City, State and Zip Code]

[Email Address]


[Recipient’s Name]

[Company’s Name]

[City, State and Zip Code]

[Fax Number]

Re: Application for a Waiver

To Whom It May Concern,

I am writing to request a waiver on the fees accrued from [Reason for payment]. The amount incurred and I am requesting a waiver is [Amount]. Due to financial difficulties from unforeseen harsh business operations, I have not met my payment obligations.

With a [Duration] waiver on fees, I will be able to get my accounts in order and proceed to make the payments as previously agreed. Your assistance in this matter will be highly appreciated and critical to the survival of our business.

Please find enclosed documentation to complete this waiver request. Thank you for your time.


[Applicant’s Signature]

[Applicant’s Name]