Wells Fargo Bank Purchasing Card Dispute Form - Concordia College

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Wells Fargo Bank Purchasing Card Dispute Form
Wells Fargo must receive transaction dispute within 60 days of posting to your account.
Attn: Dispute & Loss Specialist
Date: ______________________
Company Name: _________________________________________
Account Number: ________________________________________
Transaction Date: ________________ Amount: _______________
Merchant Description: _____________________________________
Please take a moment and check the appropriate statement that validates your dispute. Please attach
any supporting documentation that validates your dispute, such as: credit memos, letter to merchants,
sales slips or proof of payments.
____ I certify that the transaction disputed was not made by me or the person authorized by me to use
the card, nor were the goods or services represented by this transaction received by myself or a person
authorized by me.
____ Although I did engage in the above transaction, I am disputing the entire charge, or a portion in the
amount of $________. I have contacted the merchant and requested a credit to my account for the
reason explained in the attached letter.
____ The enclosed sales slip for $ ________ appeared on my statement as $ ________.
____ The enclosed credit memo: ____ has not posted to my account OR was listed
as a purchase on my statement/activity report.
____ I did not receive the service and/or merchandise. I have contacted the merchant and they have not
resolved my dispute. I expected to receive the merchandise/services on ____/____/____.
____ I have already paid for the transactions shown above by: ___ check ___ cash ___ money order ___
other credit card.
__________________________________ __________________ _____________________
Your Signature
Date
Phone Number
Please return this form immediately. We appreciate your cooperation and urge you to contact us at 800-
932-0036, if you have any questions. Fax completed form to 415-975-6635.

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