[Date]

[Your Name]

[Your Address, City, State, Zip Code]

[Your Account Number]

[Name of Debit Card Issuer]

[Billing Inquiries]

[Address, City, State, Zip Code]

Dear Sir or Madam:

I am writing to dispute a debit in the amount of [$______] on my account. The amount is inaccurate because the merchandise I ordered was not delivered. I ordered the merchandise on [date]. The seller promised to deliver the merchandise to me on [date], but I never got it. [If appropriate, include: When I placed my order, the seller did not tell me my account would be debited before shipping.]

I am requesting that the error be corrected, that any finance charges related to the disputed amount be credited to my account, and that I get an accurate statement.

Enclosed are copies of [use this sentence to describe any enclosed information, like sales slips, payment records, documentation of shipment or delivery dates] supporting my position and experience. Please correct the debiting error promptly.

Sincerely,

[Your name]

Enclosures: [List what you are enclosing.]