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{DATE, ex. Wednesday, July 11, 2006}

{Name, Company & Address, ex.
Mark Myer
XYZ Bank
1234 First Street
Suite 567
Anycity, Anystate  85245}

Dear {NAME, ex. Mark Myer},

In reference to your bank statement of {DATE, ex. July 30, 2006} for our {savings / checking} account #{ACCOUNT NUMBER}, I kindly request that a copy of the debit memo for the following service charge be forwarded to me:

DATE                AMOUNT
5/5/98               $21.00}

As we are unable to reconcile this charge, I would appreciate any clarifying information you may have.



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