Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
LACARTE DISPUTED ITEM AS704
Check the box most appropriate to your dispute. Questions may be directed to Bank of America at 1-888-449-2273.
Alteration of Amount
The amount of the sales draft has been altered from $____________________ to $____________________.
A copy of the sales draft is attached.
Unauthorized Charge due to Vendor Error
I certify the charge listed above was not authorized by me. I have not ordered merchandise by phone or mail, or received
goods and services as represented above.
Unauthorized Charge due to Fraud
I certify the charge listed above was not authorized by me. I have not ordered merchandise by phone or mail, or received
goods and services as represented above.
Cardholder Dispute
I did participate in the above transaction; however I dispute the entire charge, or a portion thereof, in the amount of
$_________________, because_____________________________________________________________.
Credit Not Received
The merchant has issued a credit slip to me for the transaction listed above; however, the credit has not posted to my account.
The date on the voucher is between 30 & 90 days old. A copy of the credit voucher is attached.
Imprinting of Multiple Slips
The above transaction represents multiple billing to my account. I only authorized one charge from this merchant for
$________________. I am still in possession of my card.
Merchandise Not Received
My account has been charged for the above transaction, but I did not make this purchase. I have contacted the merchant to
resolve this matter.
Disputed Items
• The cardholder should always contact the merchant first to try to question/resolve the purchase. The cardholder should
obtain formal documentation from the merchant to serve as proof of his/her attempt to question/resolve the matter. The
formal documentation should consist of names, dates, and times of when the merchant was contacted. The bank will
not accept a dispute without the formal documentation.
• Absolutely no transactions can be disputed after 60 days of the transaction date. The bank will NOT accept the dispute.
___________________________________________ ______________________
Employee’s Signature Date
Employee (Cardholder)
Phone Fax E-mail
Department
Contact
Phone Fax E-mail
Statement Date Transaction Date
Merchant
Description
Amount Posting Date
Reference #
Rev 6/16
