[DATE, ex. Wednesday, June 11, 1998]
 

[NAME, COMPANY AND ADDRESS, ex.
John Smith
XYZ Inc.
1234 First Street
Suite 567
Anycity, Anystate  85245]

Dear [NAME, ex. John Smith], 

I am writing to request that you discard our statement of [DATE, June 1, 1998] as we have made a mistake.  [STATE NATURE OF ERROR, ex. Namely, that statement fails to reflect your payment of $12,232.23 on May 15].

Enclosed, please find a corrected statement, showing a new balance of $[AMOUNT].  Please accept my apologies for the error and any inconveniences it may have caused. 

Sincerely,

[YOUR NAME, ex. Jill Jones]