1234, Main Street
Boston, MA 02123
05 April, 2005
<Recipient Address Goes Here>
After careful consideration, I have decided that I would like to <buy/sell> <number of shares> shares of <company name> stock. I believe the current stock price is <$amount> per share. I am hereby authorizing you to conduct this transaction on my behalf. I would appreciate receiving written confirmation that this <purchase/sale> has been completed.
Thank you for your assistance in this matter.
encl: <List of enclosed items goes here>