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

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

Dear [NAME, ex. Link Building],

I enclose a completed medical claim form together with receipts totaling $[AMOUNT OF RECEIPTS, ex. $233.29] in respect of [DESCRIBE NATURE OF AMOUNTS PAID, ex. minor surgery administered to our employee, [NAME OF EMPLOYEE].

Kindly provide us with a Check payable to the employee in the above amount.

Please address all correspondence to our address noted on our letterhead and marked “Personal and Confidential”.

Sincerely,

[YOUR NAME, ex. Jill Jones]