Scotiabank Commercial Card Dispute Form
Trademark of The Bank of Nova Scotia.
44 King Street West
Transit 05082
Toronto, Ontario M5H 1H1
e-mail: commer
cialcard@scotiabank.com
www.scotiabank.com
If you have a transaction appearing on your statement that you are disputing you may complete this form and
send to:
Scotiabank Commercial Card Service Centre,
P.O. Box 4100, Postal Station “A”, Toronto, ON, M5W 1T1 or fax: (416) 701-7022
Please Print
Account No. |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Amount $__________________
Posting Date ______/______/_______ Transaction Date: ______/______/_______
MM DD YY MM DD YY
Reference Number
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Description
1. The amount of my sales draft was increased from $_________________ to $_________________; or my sales
slip was added incorrectly. Enclosed is my copy of the sales draft which shows the correct amount.
2. I certify that the charge(s) listed above was/were not made by me or a person authorized by me to use my
card, nor were the goods or services represented by the transaction received by me or a person authorized
by me. (If you do not recognize the sale(s), please choose this option).
3. I have not received the merchandise which was to have been shipped to me. I contacted the merchant
on ______________________ and requested that my account be credited.
4. The attached credit slip was listed as a sale on my statement.
5. I was issued a credit card slip which was not posted on my statement. A copy of my credit slip is enclosed.
6. I certify that the charge in question was a single transaction, but was posted twice on my statement. I did not
authorize the second transaction. (Please note on which dates the sale in question posted to your account.)
7. I notified the merchant on _____________________ to cancel the pre-authorized order (reservation).
Please note cancellation number, if applicable __________________.
8. Although I did engage in a transaction at the merchant, I was billed for __________________ transaction(s)
totalling $____________________ that I did not engage in nor did anyone else authorized to use my card.
9. Merchandise which was shipped to me has arrived damaged and/or defective. I have returned it and
requested that my account be credited.
Name (Please Print) _________________________________________________________
Company _________________________________________________________________
Signature _________________________________ Date ___________________________
Telephone No. Work (________)_______________________________________________
Fax (________)____________________________________________
hgh
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