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[Senders Name]
[Address line 1]
[Address line 2]
[State, ZIP Code]

Sample Letter #3: Request a refund or reimbursement

[Letter Date]

[Recipients Name]
[Address line 1]
[Address line 2]
[State, ZIP Code]


[Subject: Normally bold, summarizes the intention of the letter] -Optional-


Dear [Recipients Name],



During my business trip to Washington two weeks ago, I came down with a bad case of the flu. I had to visit the hospital to get checked out and while they were willing to accept my insurance and send the bill directly to you I had to pay cash for the medicine that was prescribed to me.

With this, I would like to ask that you reimburse me for the amount that I had to pay for the medication. I have attached the receipt and are hoping to hear back from you or get results regarding this request of mine within the week.

Thank you for your time and effort.



Sincerely,

[Senders Name]
[Senders Title] -Optional-

[Enclosures: number] -Optional-

cc: [Name of copy recipient] -Optional-