Request to remove party from your account

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.


Robert Anderson

encl: <List of enclosed items goes here>

Download request to remove party from your account In Word Format

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