Printable Business Form Templates
Request Credit Card Chargeback Business Form Template

1285 Mulberry St.
Anytown, CA 95928
(555) 555-1212
[email protected]

November 8, 2008

National Credit Card
345 Broadway
Anytown, CA 95928

To Whom It May Concern:

I am writing to request a chargeback for a transaction made on my credit card, (#123-4567-8910), on Nov. 5, 2008, in the amount of $759.89 to XYZ Retailer.

Please do not honor the charge, and if it has already been processed, please reverse the charge.

The reason for the chargeback is defective merchandise. The refrigerator I ordered does not cool sufficiently, despite five service calls over the course of a week.


Danny Daniels

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