[Your Name]

[Street Address]

[City, ST ZIP Code]

[Date]

[Recipient Name]

[Title]

[Company Name]

[Street Address]

[City, ST ZIP Code]

RE: [Account Number]

Dear [Recipient Name]:

I am disputing a credit charge from [Merchant Name] in the amount of $[amount], which is included on my statement dated [click to select a date].

On [click to select a date], I ordered [product] from the web site, [website URL]. I received an email the same day that confirmed my order in the amount above. I was also told that I would receive the merchandise within two to four weeks. However, I never received the merchandise. On [click to select a date], I contacted [Merchant Name] via email and phone, and was told that my merchandise was on backorder and expected to arrive on [click to select a date]. Again, I did not receive the merchandise.

On [click to select a date], I contacted [Merchant Name] via email and phone to request that my order be cancelled and my money refunded. [Merchant Name] would not agree to refund my money, insisting that the merchandise was on the way. On [click to select a date], I again requested that my order be cancelled and my money refunded, but I did not receive a response from the company. I have not yet received my order.

I have enclosed a copy of the bill with the disputed charge highlighted, and copies of my email correspondence with [Merchant Name]. Please investigate this dispute and provide me with a written statement of the outcome.

Thank you for your time and attention to this matter.

Sincerely,

[Your Name]

[Title]

Enclosures