[Your Name]
[Your Address]
[City, State ZIP]
[Date]
[Company Name]
[Billing/Disputes Department]
[Company Address]
[City, State ZIP]
RE: Dispute of Charge/Error - Account#
Dear Sir or Madam,
I am writing to dispute a billing error/unauthorized charge on my account ending in [last 4 digits].
Description of the Error:
Amount in Dispute: $
Date of Charge:
I am requesting that this error be corrected and the disputed amount be credited to my account. I have enclosed the following supporting documents:
☐ Copy of billing statement
☐ Receipt
☐ Correspondence
☐ Other:
Please investigate this matter and respond to me in writing within 30 days as required by law.
Sincerely,
[Your Signature]
[Your Printed Name]
Enclosures: [List any documents included]
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