Section 40A. Whoever makes, draws, utters or delivers any check, draft or order for the payment of money upon any bank or other depository which refuses to honor the same because the maker has no account with such bank or other depository or because the maker has insufficient funds on deposit therein and who fails to pay the amount of such check, draft or order within thirty days following a written demand therefor by the payee in accordance with this section and delivered to such person by regular mail and also by certified mail return receipt requested shall, in addition to any criminal penalties which may be imposed in accordance with law, be liable to the payee for the face amount of such check, draft or order, and for additional damages, as determined by the court, but in no event shall the amount of such damages be less than one hundred nor more than five hundred dollars.

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The written demand for payment required by this section shall be in the following form and shall be printed in at least ten point type in both the English and Spanish languages:

DEMAND FOR PAYMENT OF DISHONORED CHECK

DATE:_________________________________

TO:___________________________________

NAME OF MAKER

WARNING: YOU MAY BE SUED 30 DAYS AF-

TER THE DATE OF THIS NOTICE IF YOU DO

NOT MAKE PAYMENT

_______________________________________

_______________________________________

_______________________________________

LAST KNOWN RESIDENCE ADDRESS OR PLACE
OF BUSINESS

YOUR CHECK/DRAFT/ORDER IN THE AMOUNT OF $___________

DATED _________ PAYABLE TO THE ORDER OF ________________

HAS BEEN DISHONORED BY THE BANK OR OTHER DEPOSITORY UPON WHICH IT HAS BEEN DRAWN BECAUSE:

— THE MAKER HAD NO ACCOUNT WITH SUCH BANK OR DEPOSITORY

— THE MAKER HAD INSUFFICIENT FUNDS ON DEPOSIT WITH SUCH BANK OR DEPOSITORY

IF YOU DO NOT MAKE PAYMENT WITHIN THIRTY DAYS OF THE ABOVE DATE, YOU MAY BE SUED TO RECOVER PAYMENT. IF A JUDGMENT IS RENDERED AGAINST YOU IN COURT, IT WILL INCLUDE NOT ONLY THE ORIGINAL FACE AMOUNT OF THE CHECK/DRAFT/ORDER, BUT ALSO ADDITIONAL LIQUIDATED DAMAGES OF NOT LESS THAN ONE HUNDRED DOLLARS ($100.00) NOR MORE THAN FIVE HUNDRED DOLLARS ($500.00).

PLEASE MAKE PAYMENT IN THE AMOUNT OF $_____________ TO:

_______________________________________

NAME OF PAYEE

_______________________________________

_______________________________________

_______________________________________

ADDRESS TO WHICH PAYMENT SHOULD
BE DELIVERED