Wells Fargo must receive transaction dispute within 60 days of posting to your account.
Attn: Dispute and Loss Specialist
Date:
Company Name: City of Somerton
Account Number:
Transaction Date: Amount:
Merchant Description:
Please take a moment and check the appropriate statement that validates your dispute. Please attach any supporting documentation that validates your dispute, such as: credit memos, letter to merchants, sales slips or proof of payments.
______I certify that the transaction disputed was not made by me or the person authorized by me to use the card, nor were the goods or services represented by this transaction received by myself or a person authorized by me.
______Although I did engage in the above transaction, I am disputing the entire charge, or a portion in the amount of $________. I have contacted the merchant and requested a credit to my account for the reason explained in the attached letter.
______The enclosed sales slip for $_________ appeared on my statement as $_________.
______The enclosed credit memo:_________ has not posted to my account OR was listed as a purchase on my statement/activity report.
______I did not receive the service and/or merchandise. I have contacted the merchant and they have not resolved my dispute. I expected to receive the merchandise/services on / / .
______I have already paid for the transactions shown above by: ______ check ______ cash
_______ money order _______ other credit card.
Your Signature Date Phone Number
Please return this form immediately. We appreciate your cooperation and urge you to contact us at 800-932-0036, if you have any questions. Fax completed form to 415-975-6635.
(Res. 2008-011, passed 2-19-2008)