DIY Legal Forms

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Disputed Balance Notice

Date:

To:

We are in receipt of your statement dated the ____________, day of _____________ 20 __, indicating an account balance of USD$------.

We dispute said balance for the reason[s] checked.

____ Goods billed for have not been received.

____ Prices are in excess of agreed amount.

____ Prior payment made in the amount of $______on the ____________, day of _____________ 20 __.

____ Goods were unordered.

____ Goods were defective as per prior notice.

____ Goods are available for return as per our right of return and credit.

____ Other:

[Describe]

Please adjust our account.

Sincerely,

______________________