Bank Of America Commercial Card Services

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03/12
LSU SHREVEPORT
LA CARTE DISPUTED ITEM
Bank of America Commercial Card Services Fax 1-888-678-6046
Cardholder Name ___________________________________ Dept contact name _________________________________________
(Please print name as it appears on card)
Cardholder Account Number _______________________________ Contact phone/e-mail ____________________________________________
Statement Date
Transaction Date
Merchant Name/Description
Amount
Posting Date
Reference No
Check the description most appropriate to your dispute. If you have any questions, call Bank of America at 1-888-449-2273.
[ ] 1. Alteration of Amount:
The amount of the sales draft has been altered from $_____________________ to $_____________________. (Please include copy of sales draft.)
[ ] 2. Unauthorized Mail or Phone Order:
I certify the charge listed above was not authorized by me. I have not ordered merchandise by phone or mail, or received goods and services as represented above.
[ ] 3. Cardholder Dispute:
I did participate in the above transaction; however, I dispute the entire charge, or a portion thereof, in the amount of $_____________ because
_________________________________________________________________________________________________________________
[ ] 4. Credit Not Received:
The merchant has issued a credit slip to me for the transaction listed above; however, the credit has not posted to my account. The date on the voucher is between 30 and 90
days old. (Please include a copy of the credit voucher.)
[ ] 5. Imprinting of Multiple Slips:
The above transaction represents multiple billing to my account. I only authorized one charge from this merchant for $____________. I am still in possession of my card.
[ ] 6. Merchandise Not Received:
My account has been charged for the above transaction, but I have not received this merchandise. I have contacted the merchant.
[ ] 7. Merchandise Not Received:
My account has been charged for the above transaction, but I have since contacted this merchant and canceled the order. I will refuse delivery should the merchandise be sent.
[ ] 8. Merchandise Returned:
My account has been charged for the above transaction, but the merchandise has been returned. Provide a description of the circumstances. (Please include postal receipt if
applicable.)
[ ] 9. I am no longer disputing this charge.
Cardholder signature ___________________________ _____/_____/20____ E-mail address ________________ Phone # _______________________
* * * Forward this as documentation to the La Carte Administrator. * * *

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