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Disputed Balance Notice
We are in receipt of your statement dated [Date], indicating an account balance of $------.
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 $------.
[ ] Goods were unordered.
[ ] Goods were defective as per prior notice.
[ ] Goods are available for return as per our rights of return and credit.
[ ] Other [Describe]
Please adjust our account.