Appendix A

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 53101
Phoenix, AZ 85072-3101
Phone (800) 300-3084, 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/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.

Last Published: April 27, 2004 11:50 AM
Empowered by Extend, a school software solution from