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Credit Cardholder's Inquiry Concerning
Name of cardholder: ______________(3)_________________
Cardholder's address: ____________(4)_________________
Credit Card account Number: _________(5)______________
On the periodic billing statement dated _____(6)_______,
19__(7)_, for the above-numbered credit card account, I determined
there was a billing error; specifically:
It is my belief that the posting of such debit is incorrect
Please be advised that the billing error described above
does not concern any dispute with respect to value, quality,
or quantity of the goods obtained through use of my credit
I would appreciate that the billing error be corrected, or
that you otherwise respond to this inquiry, at your earliest
Dated _________(8)_____________, 19__(9)_.
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