Identity Theft Affidavit Form - Wichita Police Department Page 10
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14SAMPLE DISPUTE LETTER FOR EXISTING ACCOUNTS
Date
Name of Company
Address
City, State, Zip Code
Re:
Your name
Your Address, City, State, Zip Code
Complaint Department
Dear Sir or Madam:
I am writing to dispute a fraudulent
charge or debit
on my account in the amount of
$______. I am a victim of identity theft and I did not generate this
charge or
debit. I am
requesting that the
charge is removed or debit be reinstated
and that any finance or
other charges related to the fraudulent amount be credited. I also request that I receive
an accurate statement.
Enclosed are copies of (use this sentence to describe any enclosed information: police
report, Identity Theft Affidavit, etc.) supporting my position. Please investigate this
matter and correct the fraudulent
charge or debit
as soon as possible.
Pursuant to FACTA, as a victim of identity theft I am also requesting that you provide
me with copies of any and all applications and business transaction records related to
the fraudulent account(s). The copies of the records can be mailed to me at the address
listed above. In addition, please make these records available to the Wichita Police
Department, Wichita, KS 67202, upon their request.
Sincerely,
Your name
Enclosed: (List everything you are enclosing)
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Parent category: Financial