Sample hardship letter

Use this as a starting point.

Subject: Hardship request, account #[number]
Hello [Company name],
I am writing to request help because of a temporary hardship. [Brief
reason, such as job loss or medical costs.]
I can pay $[amount] per month for the next [number] months. Please let
me know what options are available.
Thank you,
[Your name]
[Phone number]