Payment Dispute Notice Letter PDF

Draft a formal dispute notice when someone claims you did not pay. Document the transaction, your statement, and the resolution you are seeking.

The letter includes a checklist you can use to confirm which evidence items you are attaching.

Payment dispute notice letter

Summarize the payment, dispute the claim, and list the evidence you are including.

Sender name

Sender email or phone

Sender address

Recipient name or company

Dispute date

Recipient address

Transaction date

Amount

Payment method

Reference ID (optional)

What they claimed

Your statement

Resolution requested

Mark the evidence you are including with the letter.

Evidence 1

Item

Included?

Yes

Evidence 2

Item

Included?

Yes

Evidence 3

Item

Included?

Yes

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