Disputed Balance Notice
We are in receipt of your statement dated_______________, 201(x), indicating an unpaid account balance in the amount of $_____________. We dispute the said balance for the reason(s) noted below:
_____ The goods billed for have not been received.
_____ The prices charged by you are in excess of agreed amount.
_____ Prior payment was made in the amount of $________ on _______________, 201(x).
_____ The goods were not ordered.
_____ The goods were defective as per our prior notice to you.
_____ The goods are available for return to you in accordance with our rights of return and credit.
_____ Other: __________________________________________________
Please adjust our account accordingly.
Yours very truly,