Letter to Correct Billing Error - Template, Sample Form

BILLING ERROR DISPUTE — NOTICE PURSUANT TO THE FAIR CREDIT BILLING ACT

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________
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Telephone: ________
Email: ________
Account Number: ________

Date: ________

Sent Via: ________ (Certified Mail, Return Receipt Requested)

To the Billing Inquiries Department of:

________
________
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RE: Notice of Billing Error and Request for Correction — Account No. ________

To Whom It May Concern:

§ 1. Purpose of Notice. I am writing to notify you of, and formally dispute, a billing error appearing on my account identified above. This notice is submitted in accordance with the Fair Credit Billing Act, 15 U.S.C. § 1666 et seq., and its implementing regulation, Regulation Z, 12 C.F.R. § 1026.13. This communication is sent to the address you have designated for billing inquiries and is intended to constitute timely written notice of a billing error.

§ 2. Identification of the Account Holder. The account holder of record is ________, holder of account number ________.

§ 3. Description of the Billing Error. The disputed item is a charge in the amount of $________ (________ Dollars), posted to my account on or about ________ and identified on my statement as ________. This amount was improperly debited from my account. It reflects a charge that I did not make, did not authorize, and do not recognize.

§ 4. Statement of Dispute. The error appears on the periodic statement dated ________. I believe the statement contains an error because the amount described in § 3 above does not reflect a transaction I made or authorized. A copy of the statement on which the error appears, together with any supporting documentation, is enclosed herewith for your reference.

§ 5. Requested Relief. I respectfully request that you:

1. investigate the disputed charge described above and correct the billing error in full;
2. remove from my account any related finance charges, interest, late fees, service charges, or other amounts assessed as a consequence of the disputed charge;
3. provide me with written confirmation, together with documentary evidence supporting any portion of the charge you conclude is correct, in the event you determine that no billing error occurred; and
4. refrain from reporting the disputed amount as delinquent or taking any collection action with respect to the disputed amount or related charges during the pendency of your investigation.

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§ 8. Further Information and Contact. Should you require any additional information to investigate this matter, please contact me at the address, telephone number, or email set forth above. Please direct all correspondence regarding this dispute to me in writing at that address.

Please give this matter your prompt attention. Thank you for your cooperation.

Sincerely,

________
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Enclosures: ________