1234, Main Street
Boston, MA 02123
04 April, 2005
<Recipient Address Goes Here>
Re: Account No. <number>
I recently lost or misplaced my <type of card> card on the above-referenced account. The lost card bore the number <number from card>. I am writing to ask that you cancel that card and issue me a replacement card as soon as possible. No further use of this card should be authorized under any circumstances.
I appreciate your prompt attention to this request. If you have any questions concerning this, please do not hesitate to contact me.
encl: <List of enclosed items goes here>