Disputed Balance Notice


To:  (Creditor)


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,




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