REQUEST BANK TO CLARIFY SERVICE CHARGE

[DATE, ex. Wednesday, June 11, 1998]

[NAME, COMPANY AND ADDRESS, ex.

John Smith

XYZ Bank

1234 First Street

Suite 567

Anycity, Anystate 85245]

Dear [NAME, ex. John Smith],

In reference to your bank statement of [DATE, ex. July 30, 1998] 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

[LIST DATE & AMOUNT, ex

5/5/98 $21.00]

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

Sincerely,

[YOUR NAME, ex. Jill Jones]