Letter of Information Request on Disputed Charges : Please fill out the following form. Please print your completed form if you would like to have a copy for your records.
Dear (Courtesy and the first name of the person to be notified),
Please be advised that we have received your statement of charges and we dispute certain charges on our account for the following reasons:
Reasons for dispute
We do want to promptly reconcile our account, so we may pay and resolve this matter; however, we find we need the below checked information or documents:
Copies of charges noted on reverse side
Copies of purchase orders
Debit memoranda outstanding
List of goods claimed as shipped
Other :Thank you for your immediate attention. Upon receipt of the requested information we shall give your statement our prompt consideration.
Very truly yours,
Letters for Credit and Collection Index
Letter of Information Request on Disputed Charges
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