TO: ___________________________

___________________________

Name of cardholder: __________________________________

Cardholder's address: ________________________________

Credit Card account Number: __________________________

On the periodic billing statement dated _______________, 20______, for the above-numbered credit card account, I determined there was a billing error; specifically:

(DESCRIBE ERROR)

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

(DISCUSS REASON)

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 _________________________, 20______.

______________________________

NOTICE

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.