Request For Bank Statement

{Your Name}
{Your Address}
{Your Phone Number}

{Name}
{Bank Name}
{Address}

{Date}

Dear {Name},

This letter is a formal request to receive previous bank statements from my account. The account number is {number} and the name listed on the account is {Name}. I would like all the bank statements from {date} to {date} sent to the address listed above.

Please {deduct the service charge amount from my checking account/accept the enclosed check for the service charge amount}.

If you have any questions, or would like to speak to me further concerning this matter, please contact me at {phone number} or {email}.

Sincerely,

{Sender Name}

Acceptance of Notice

Receipt of the above notice is hereby acknowledged and accepted by: _________________________________

The _______ day of ______________, 20______

By: ____________________________________

Title: ___________________________________