COMMERCIAL CARD CLAIMS

STATEMENT OF DISPUTED ITEM

 

Instructions: Your company should first make good-faith efforts to settle a claim for purchases directly with the merchant. If assistance

from Bank of America is required, please complete this form, and mail with required enclosures within 60 days from the

billing close date to:

 

Bank of America – Commercial Card Services Operations

P. O. Box 53142

Phoenix, AZ 85072-3142

 

FAX (888) 678-6046

 

Company Name:

Account Number:

Cardholder Name:

 

This Charge appeared on my statement, billing close date:

Transaction Date:

Reference Number:

Merchant Name/Location:

Posted Amount: Disputed Amount:

 

 

 

_______________________ _______________________ __________ __________

(Cardholder Signature) (Authorized Participant Signature) (Date) (Phone Number)

 

Please Check Only One

 

1._____

Unauthorized Transaction:

I did not authorize, nor did I authorize anyone else to engage in this transaction. No goods or

services represented by the above charge were received by me or anyone I authorized. My Bank of America card was in my

possession at the time of the transaction.

2._____

Charge Amount Does Not Agree With Order Authorizing the Charge:

The amount entered on the sales slip was increased

from $__________ to $__________. I have enclosed a copy of the unaltered sales slip.

3._____

Merchandise or Services Not Received:

I have not received the merchandise or services represented by the above

transaction. The expected date of delivery of services was __________. (Please describe your efforts to resolve this matter

with the merchant, the date(s) you contacted them and their response.)

 

4._____

Defective or Wrong Merchandise:

I returned the merchandise on __________ because it was (check one):

_____ defective; _____wrong size; _____wrong color; _____wrong quantity.

(Please describe your efforts to resolve this matter with the merchant, the date(s) you contacted them, their response and proof

of the return of merchandise. Please provide a detailed description of the wrong or defective nature of the merchandise.)

5._____

Recurring Charges After Cancellation:

On __________ (date), I notified the merchant to cancel the monthly/yearly

agreement. Since then my Bank of America account has been charged _____ time(s). (Please enclose a copy of the

merchant’s confirmation of your cancellation request.)

6._____

Recurring Charges Already Paid by Other Means:

I already paid for the goods and/or services represented by the above

charge by means other than my Bank of America Commercial Card. (Please provide a copy of the front and back on the

cancelled check, money order, cash receipt, credit card statement, or other documentation as proof of purchase/payment.

Describe your efforts to resolve this matter directly with the merchant, the date(s) you contacted them, and their response.)

7._____

Credit Appears as a Charge:

The enclosed Credit Voucher appeared as a charge on my Bank of America Commercial Card

account.

8._____

Credit From Merchant Not Received:

I did not receive credit for the enclosed Credit Voucher within 30 calendar days from

the date it was issued to me by the merchant shown above. (Please describe your efforts to resolve this matter with the

merchant, the date(s) you contacted them and their response. Provide a detailed statement explaining your reason(s) for

disputing this charge.)

9._____

Hotel Reservation Cancelled:

I made a reservation with the above hotel which I later cancelled on __________ (date) at

__________ (time). I received a cancellation number which is _______________. (Please describe how the reservation was

cancelled, proof of cancellation and attempts to resolve this issue with the merchant.

_____ I was not given a cancellation number.

_____ I was not told at the time that I made the reservation that my account would be charged for a “No Show”.

_____ I was not informed of the cancellation policy.

10.____

Double or Multiple Charges:

My Bank of America Commercial Card A

ccount has been double charged. The valid charge

appeared on __________ (date). The duplicate charge(s) appeared on _______________.

11.____

Do Not Recall the Transaction:

The statement has an inadequate description of the charge. Please supply supporting

documentation.

12. ___

Other; Above Descriptions Do Not Apply

: Please attach a detailed letter explaining the reason for your dispute and your

attempts to resolve this issue with the merchant.