Dear _______________

In connection with an examination of our financial statements by ____________________ (name of accounting firm), Certified Public Accountants, _________________________________________________ (address, city, state, zip) we will appreciate it if you will indicate the correctness of the information.

Our records indicate that, at the close of business on ____________ (date) , the amount payable on your account was _________________ (amount) .

Please sign the confirmation form in the space provided below if this amount agrees with your records. If it does not agree, do not sign below but explain and sign on the reverse side. Please return this form directly to our accountants in the enclosed envelope.