Refuse Credit Card Charge

[Your Name]

[Address]

[City, State, Zip]

[Date of letter]

[Recipient’s Name]

[Company Name]

[Address]

[City, State, Zip]

Dear [Recipient’s name],

I am writing to you today regarding our phone conversation on ___/___/_____ and per our discussion I am giving you a written notice to refuse a credit card charge:

Name: ________________________________________________________________________________________

Amount: $_____________________

Date: ___/___/_____

Credit Card #: _____________________________________ Exp. Date: ___/___/_____

Item purchased: ________________________________________________________________________________

I am refusing this charge because: _________________________________________________________________

_____________________________________________________________________________________________.

Until this matter is resolved, do not pay the item referenced above. Please contact me if you have any questions or need additional information regarding this Credit Charge Refusal.

Best regards,

[Your Signature]