Sample
[DATE, ex. Wednesday, July 11, 2006]
[NAME, BANK AND ADDRESS, ex.
Robert Brown
XYZ Bank
1234 First Street
Suite 567
Anycity, Anystate 85245]
Dear [NAME, ex. Robert Brown],
You are hereby authorized to release to [NAME OF INDIVIDUAL OR COMPANY] all banking information requested by [him / her / it] relating to our Account No. [ACCOUNT NO., ex. 12345678].
This shall be your good and sufficient authority for so doing.
Sincerely,
[YOUR NAME]