1234, Main Street
Boston, MA 02123
04 April, 2005
<Recipient Address Goes Here>
Re: Account No. <account number>
Please be advised that, as the primary <cardholder/account holder>, I wish to have <name> removed from my account. Effective immediately, I request that all further charging privileges for <name> be revoked for this account. All future statements, correspondence and inquiries should be sent only to me at the address listed above.
I would appreciate it if you would provide me with written confirmation that <name> is no longer a cardholder on this account. Thank you for your immediate attention to this request. I look forward to hearing from you.
encl: <List of enclosed items goes here>