1234, Main Street
Boston, MA 02123
<Recipient Address Goes Here>
<Our/My> employee <full name> has been summoned to appear for jury duty on <date>. I wish to ask for <short name> to be excused because of the hardship it would place on our company. <Description of hardship.>
<Optional alternate date.>
If you need to verify the circumstances of <short name>’s employment or of this request you can reach me at <telephone number>. Thank you for your consideration in this matter.