Date: _
To: _
We are in receipt of your statement dated _, 19_, indicating an account balance of $_. We dispute said balance for the reason(s) checked.
____ Goods billed for have not been received. ____ Prices are in excess of agreed amount. ____ Prior payment made in the amount of $_ on _, 19_. ____ Goods were unordered. ____ Goods were defective as per prior notice. ____ Goods are available …