Dear …
RE: Request Audit - Payment Records - __(Reference #/ Name)__
I am sending this letter to request a formal review of my __(type of)__ payment records with __(Name of organization/etc.)__. According to my personal records, I believe that I have __(met all my/made an overpayment on my/etc.)__ __(type of)__ payment obligations over the last __(length of time)__. Therefore, I ask you to kindly perform an audit on my __(account/payment records)__ to verify my current payment status.
In addition, I ask that you provide me with a Statement of Account showing all of the payment transactions from __(date)__ to __(date)__. I wish to compare these records with mine to ensure that they coincide. Please forward the Statement of Account to __(address)__.
Thank you for responding quickly to this request. I appreciate your time in reviewing my __(account/payment records/etc.)__, and look forward to hearing from you soon with the results.
Yours truly,