[DATE, ex. Monday, March 31, 2008]

[NAME, COMPANY AND ADDRESS, ex.
Link Building
XYZ Bank
1234 First Street
Suite 567
Anycity, Anystate  85245]

Dear [NAME, ex. Link Building],

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]