Finance & banking
Transaction dispute template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
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Preview — US standard
Billing Error Dispute Letter
Your Name
Your Address
Your Phone or Email
Date: Letter Date
Sent by: Certified Mail with Return Receipt, or the Card Issuer's Dispute Address or Online Form
To: Card Issuer or Bank Name
Billing Disputes / Billing Inquiries
Billing Inquiries Address from the Statement
Re: Account ending in Last Four Digits of Account
Dear Sir or Madam:
I am writing to dispute the following charge on my statement dated Statement Date:
| Date | Merchant | Amount | Reference |
| --- | --- | --- | --- |
| Transaction Date | Merchant Name | $Disputed Amount | Transaction Reference |
Reason
This charge is in error because Reason, such as I did not make or authorize it, I was charged twice, the amount is wrong, or I did not receive the goods or services.
Merchant Contact Attempts, with Dates, or Not Applicable
Request
Please correct this error by crediting $Disputed Amount and any related finance charges or fees to my account, and send me an explanation of the result.
For a credit card, I am sending this letter within 60 days after the first statement showing the error, as the Fair Credit Billing Act requires. For a debit card or electronic transfer, I am giving notice of an error under the Electronic Fund Transfer Act and Regulation E. If the card was lost or stolen: Date You Noticed and Reported the Loss, or Not Applicable
Copies of supporting documents are enclosed: Enclosed Documents, such as receipts or the merchant's emails.
Sincerely,
Your Signature
Your Printed Name