Letter to Financial Institution Requesting a Chargeback

Important: This letter can be used as a guide. You must insert your own details where appropriate and delete any information that is not relevant to your situation. Always date your letters. Always keep a copy of the letter you send. Get legal advice if you do not understand.

[Your name and address]

[write Date here]

The Manager
[Name of bank, building society or credit union]
[Name of branch]
[Address]

Dear Manager,

RE: REQUEST FOR CHARGEBACK

My/Our account name:
Account No. XXXXX

I am writing to request that the following transaction be charged back.

The details of the transaction are as follows:

Date of transaction:
Amount of transaction:
Name of merchant:
Reasons for the request for chargeback:
[Give reasons why the transaction should be charged back eg. goods not received, did not work etc. Make sure you provide evidence of this if possible]

Please let me know when the above transaction has been charged back to the merchant.

Yours faithfully,

[Signature]

[Name]

[Signature]

[Name]

Your address:

*All account holders must sign

Warning: This letter is information only and should not be relied upon as legal advice.