Date:

To:

VIA CERTIFIED MAIL, Return Receipt Requested

Re: Notice to stop credit charge

Dear:

Please be advised that on the _____ day of ____________, 20__, I, _______________________the undersigned charged a sum of __________ dollars ($ ) on a transaction with ____________________.

I hereby instruct you not to honor said charges or issue payment to the company for the following reasons:

Thank your for your cooperation.

____________________________________

Cardholder

____________________________________

Address

____________________________________

____________________________________

Credit Card Number

Warning:

These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.

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