DIY Legal Forms

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Disputed Balance Notice

Date:

To: [Creditor]

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 $------.

on [Date].

[ ] 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.

Sincerely,

______________________