[Your Name]

[Street Address]

[City, ST ZIP Code]

[Date]

[Recipient Name]

[Title]

[Company Name]

[Street Address]

[City, ST ZIP Code]

Dear [Recipient Name]:

This letter will serve as written confirmation that on [date], I lost my [card type] credit card, number [card number], expiration date [date]. Please cancel the card immediately and issue a new one.

Also, please forward me a current statement so that I can verify that no unauthorized charges have been made to the card since I lost it.

Thank you for your prompt attention to this matter.

Sincerely,

[Your Name]