Disputed Balance Notice



Date: _


To: _


We are in receipt of your statement dated _, 20_, indicating an account balance of $_.

We dispute said balance for the reason(s) checked.

____ Goods invoiced for have not been received.

____ Prices are in excess as per the agreed amount.

____ Prior payment made in the amount of $_ on _, 20_.

____ Goods were unordered.

____ Goods were faulty as per prior notice.

____ Goods are available for return as per our right of return and credit.

____ Other (Describe) _


Please adjust our account accordingly.


Best Regards,



Disputed Balance Notice

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