[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Company Name] [Company Address] [City, State, ZIP Code] Subject: Disputed Balance Notice — Account: [Account Number] Dear [Company Name], I hope this letter finds you well. I am writing to formally dispute the balance stated on my recent billing statement for the aforementioned account. Upon carefully reviewing the charges, I have identified several discrepancies that need to be resolved to ensure the accuracy of my account. To provide you with a comprehensive overview, I have outlined the disputed balance and the specific discrepancies below: 1. [Disputed Charge/Debit] — [Amount]: According to my records, I have not authorized or incurred the aforementioned charge on the specified date. I request a detailed breakdown of this charge along with supporting documentation, such as receipts or transaction records, to substantiate its validity. 2. [Disputed Charge/Debit] — [Amount]: This charge appears to be significantly higher than the usual/expected amount for the service provided. I kindly request an itemized statement outlining the factors contributing to this increase, as well as relevant contract agreements or agreements detailing any changes in pricing. 3. [Disputed Charge/Debit] — [Amount]: The transaction date provided conflicts with my own records, leading me to believe there may have been an error in recording or processing this charge. To accurately evaluate the situation, I kindly request the transaction details, including date, time, and location, along with any applicable supporting documentation. I have taken the liberty of gathering relevant evidence to support my claim. Attached to this letter, you will find copies of [relevant documents, such as receipts, billing statements, or agreements] highlighting the aforementioned discrepancies. I believe it is crucial to ensure transparency and prompt resolution regarding this matter. In accordance with the Fair Credit Billing Act, I assert my rights to have a clear understanding of the charges on my account and to have these discrepancies promptly addressed and corrected. Therefore, I kindly request the following: 1. Provide a detailed investigation into the disputed charges, which includes obtaining all necessary documentation to validate or rectify the concerns raised. 2. Temporarily suspend any collection efforts regarding the disputed balance until a resolution is reached. 3. Issue a written response within [timeline suggested, e.g., 30 calendar days] from the date of this letter, confirming the receipt of my dispute and the initiation of an investigation, as well as a tentative timeline for resolving the matter. Furthermore, please note that until this matter is resolved to my satisfaction, I will withhold any payments relating to the disputed amount. I trust that you will act promptly to address this issue, as your attention and cooperation in resolving this dispute are greatly appreciated. I look forward to your prompt response and the resolution of this matter. In the event that I do not receive a satisfactory response within the given timeframe, I reserve the right to escalate this dispute and explore further legal remedies available to me. Thank you for your immediate attention to this matter. Sincerely, [Your Name]
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.