____________(2)____________

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:

(DESCRIBE ERROR)

It is my belief that the posting of such debit is incorrect because:

(DISCUSS REASON)

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 card.

I would appreciate that the billing error be corrected, or that you otherwise respond to this inquiry, at your earliest convenience.

Dated _________(8)_____________, 19__(9)_.

____________(10)______________