To:
Address:

Dear Sir/Madam,

We are conducting an audit of the financial statements of for the year ended . In accordance with auditing standards, please confirm directly to us the amount owed by your organization to our client as of .

Please complete the section below and return this form directly to our office at your earliest convenience.

Details as per our records:

Account Name:
Account Number:
Balance as of :

If there are any differences, please kindly provide details below:

Authorized Signature:
Name:
Title:
Date: