The notice of dishonor shall be sent by mail to the drawer at the drawer's last known address, and the notice shall be substantially in the following form:
NOTICE OF DISHONOR OF CHECK
A check drawn by you and made payable by you to . . . . . . in the amount of . . . . . . has not been accepted for payment by . . . . . ., which is the drawee bank designated on your check. This check is dated . . . . . ., and it is numbered, No. . . . . . ..
You are CAUTIONED that unless you pay the amount of this check within fifteen days after the date this letter is postmarked, you may very well have to pay the following additional amounts:
(1) Costs of collecting the amount of the check, including an attorney's fee which will be set by the court;
(2) Interest on the amount of the check which shall accrue at the rate of twelve percent per annum from the date of dishonor; and
(3) Three hundred dollars or three times the face amount of the check, whichever is less, by award of the court.
You are also CAUTIONED that law enforcement agencies may be provided with a copy of this notice of dishonor and the check drawn by you for the possibility of proceeding with criminal charges if you do not pay the amount of this check within fifteen days after the date this letter is postmarked.
You are advised to make your payment to . . . . . . at the following address: . . . . . . . . . .