12th September 2010
Maximum Insurance Inc.
1234 Main Street
Arlington, TX 76010
Re : Policy Number 3901178 Cancellation
I am sending you this written notice to formally request the cancellation of my insurance policy effective 10th August, 2010. I would appreciate you sending me written confirmation within 30 days that the cancellation has been put into effect. Please refund the unused portion of my policy premium. I have informed the bank to cease any further transfer towards your account and I request you as well to cease charging my bank account for payments of monthly premium.
Thank you for your prompt action on this matter.
25 South Street
Fort Worth, TX 76052