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

[NAME, Bank AND ADDRESS, ex.

John Smith
YZ Bank
1234 First Street
Suite 567
Anycity, Anystate  85245] 

Dear [NAME, ex. John Smith],

You are hereby authorized and directed to debit our account no. [ACCOUNT NUMBER, ex. 12345678] in the amount of [AMOUNT OF DEBIT, ex. $8,236.09] in payment of [NATURE OF DEBIT, ex. your loan commitment fee]. 

This shall be your good and sufficient authority for so doing.

[NOTE: IF MORE THAN ON SIGNATURE IS REQUIRED ON ACCOUNT, MAKE SURE BOTH BANK SIGNING OFFICERS SIGN LETTER] 

Sincerely,