Introducing Referent – AI-native practice management software for modern law firms.
Explore Referent[Merchant/Business Name]
[Business Address]
[City, State, ZIP]
[Phone] | [Email] | [Website]
Date: [Date]
To: [Bank/Processor Name]
Re: Chargeback Dispute – Request for Reversal
Merchant Account ID (Optional): [MID]
Case/Chargeback ID: [Case ID]
Cardholder Name: [Name]
Transaction Date: [Date]
Transaction Amount: $[Amount]
Transaction ID: [Transaction ID]
Order/Invoice Number: [Order #]
Reason Code (If Known): [Reason code and description]
Product/Service Purchased: [Description]
Delivery/Service Date: [Date]
Cardholder Name: [Name]
Transaction Date: [Date]
Transaction Amount: $[Amount]
Transaction ID: [Transaction ID]
Order/Invoice Number: [Order #]
Reason Code (If Known): [Reason code and description]
Product/Service Purchased: [Description]
Delivery/Service Date: [Date]
We respectfully dispute this chargeback because [brief reason: the goods/services were delivered as described / the customer authorized the transaction / the refund policy was disclosed and acknowledged / the charge is not duplicate / other].
3.1 Order and Authorization.
The customer placed the order on [Date] using [checkout method] and received an order confirmation at [Email].
The transaction was authorized on [Date/Time] with authorization code [Code] (if available).
The customer placed the order on [Date] using [checkout method] and received an order confirmation at [Email].
The transaction was authorized on [Date/Time] with authorization code [Code] (if available).
3.2 Delivery / Service Completion.
Delivery was completed on [Date] to [Address], confirmed by: ☐ Carrier proof of delivery ☐ Signature confirmation ☐ Tracking number [Tracking].
For digital goods/services: access was provided on [Date], with evidence including: ☐ Login/access logs ☐ IP address [IP] ☐ Download timestamp [Time] ☐ Account activity.
Delivery was completed on [Date] to [Address], confirmed by: ☐ Carrier proof of delivery ☐ Signature confirmation ☐ Tracking number [Tracking].
For digital goods/services: access was provided on [Date], with evidence including: ☐ Login/access logs ☐ IP address [IP] ☐ Download timestamp [Time] ☐ Account activity.
3.3 Customer Communications.
On [Date], the customer contacted us regarding [issue], and we responded on [Date].
The customer acknowledged receipt/usage on [Date] (if applicable).
On [Date], the customer contacted us regarding [issue], and we responded on [Date].
The customer acknowledged receipt/usage on [Date] (if applicable).
3.4 Policies Disclosed.
Our refund/cancellation policy was displayed at checkout and available at: [URL or location]. The customer agreed to the policy on [Date] via: ☐ Checkbox ☐ Terms acceptance ☐ Signed agreement.
3.5 Refund Status.
☐ No refund was requested prior to the chargeback.
☐ A refund was offered on [Date], but the customer declined.
☐ A refund was issued on [Date] in the amount of $[Amount] (attach proof), which makes the chargeback improper as a duplicate remedy.
☐ No refund was requested prior to the chargeback.
☐ A refund was offered on [Date], but the customer declined.
☐ A refund was issued on [Date] in the amount of $[Amount] (attach proof), which makes the chargeback improper as a duplicate remedy.
We have attached the following evidence:
☐ Order confirmation / invoice
☐ Receipt / payment confirmation
☐ Proof of delivery (tracking, signature, carrier confirmation)
☐ Service completion records
☐ Digital access logs (if applicable)
☐ Customer communications (emails, chat transcripts)
☐ Refund/cancellation policy proof and acceptance
☐ Customer identity verification (AVS/CVV results, if allowed)
☐ Other: [List]
☐ Order confirmation / invoice
☐ Receipt / payment confirmation
☐ Proof of delivery (tracking, signature, carrier confirmation)
☐ Service completion records
☐ Digital access logs (if applicable)
☐ Customer communications (emails, chat transcripts)
☐ Refund/cancellation policy proof and acceptance
☐ Customer identity verification (AVS/CVV results, if allowed)
☐ Other: [List]
Based on the documentation above, we respectfully request that the chargeback be reversed and the funds returned to our merchant account.
If additional information is needed, please contact:
Name: [Name]
Title: [Title]
Phone: [Phone]
Email: [Email]
Sincerely,
[Authorized Name]
[Title]
[Merchant/Business Name]
[Authorized Name]
Title: [Title]
Date: [Date]
Signature: ___________________________
Each template already follows legal structure and best practices.
The agreement is automatically filled and adapted to your inputs.
Check the generated document, make edits if needed, and download a ready-to-use agreement.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Frequently asked
A chargeback dispute letter is a written response a merchant submits to a bank or payment processor to challenge a customer’s chargeback. It summarizes the transaction, explains why the chargeback is not valid, and references supporting evidence such as receipts, delivery confirmation, customer communications, and the merchant’s refund or cancellation policy.
You should send it as soon as you receive the chargeback notification and before the deadline set by your processor. Deadlines can be short, so it helps to gather and submit evidence quickly.
Helpful evidence includes order confirmation, invoices/receipts, proof of delivery or service completion, IP logs for digital goods, customer acknowledgments of policies, prior refund history, communications showing the customer received what they purchased, and any signed agreements.
Keep it clear and factual: identify the transaction, state the reason you’re disputing the chargeback, list supporting evidence, and request reversal of the chargeback. Avoid emotional language and stick to documented facts.
Not always. Some chargebacks are valid (fraud, duplicate charge, not received, defective). Disputes work best when you have strong documentation. Also, certain product categories and card network rules can affect outcomes, so align your letter with your processor’s guidance.
AI Lawyer is an AI-powered assistant that helps you create and customize legal and business document templates online. It guides you through key sections, suggests wording, and explains complex concepts in simple language. AI Lawyer does not replace a licensed attorney or provide legal advice, but helps you prepare better documents faster and more confidently.
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