_________________ (date line)
___________________________ (name of bank)
___________________________ (address)
___________________________ (city, state, zip)
____________________________ (country)

Sir:

We hereby agree to accept and pay at maturity any draft or drafts on us, at ______________ day’s sight, issued by _______________________ (name of individual) of your city, to the extent of ______________________ (amount ), and negotiated through your bank.

Most respectfully yours,

_____________________
[...]