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TO:  ____________(1)____________


Name of cardholder:  ______________(3)_________________

Cardholder's address:  ____________(4)_________________

Credit Card account Number:  _________(5)______________

            On the periodic billing statement dated _____(6)_______, 19__(7)_, for the above-numbered credit card account, I determined there was a billing error; specifically:


            It is my belief that the posting of such debit is incorrect because:


            Please be advised that the billing error described above does not concern any dispute with respect to value, quality, or quantity of the goods obtained through use of my credit card.

            I would appreciate that the billing error be corrected, or that you otherwise respond to this inquiry, at your earliest convenience.

Dated _________(8)_____________, 19__(9)_.



            The information in this document is designed to provide an outline that you can follow when formulating business or personal plans.  Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.


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