"Statement of Disputed Item - Commercial Card Claims" - Florida

This Florida-specific printable "Statement of Disputed Item - Commercial Card Claims" is a part of the legal paperwork issued by the Florida Department of Juvenile Justice.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

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Download "Statement of Disputed Item - Commercial Card Claims" - Florida

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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 fax or 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
Phone (800) 352-4027, 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 Account 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.
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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 fax or 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
Phone (800) 352-4027, 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 Account 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.
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