NOTICE
DISPUTED BALANCE OF BILL

Date: ___________________________

To: _____________________________

We acknowledge receipt of your bill dated _________________, indicating an account balance of $ _______________.  We dispute said balance because:

____ Goods have not been received.

____ No credit for prior payment made in the amount of $ _________.

____ Goods were not ordered.

____ Goods were defective as per prior notice.

____ Goods are available for return as per our rights of return and credit.

____ Other ___________________________________________________________ ____________________________________________________________________.

Please adjust our account.

____________________________
Signature