Signature: _____________________________ Date: _______________________________

Please confirm the balance by signing and returning a copy of this letter to us by [Deadline].

I confirm that the outstanding balance of $[Amount] is accurate.

Dear [Recipient's Name],

I do not confirm that the outstanding balance of $[Amount] is accurate. The correct balance is $[Amount].

To confirm the balance, please sign and return a copy of this letter to us: