Scotiabank Commercial Card Dispute Form
™ Trademark of The Bank of Nova Scotia.
44 King Street West
Toronto, Ontario M5H 1H1
If you have a transaction appearing on your statement that you are disputing you may complete this form and
Scotiabank Commercial Card Service Centre,
P.O. Box 4100, Postal Station “A”, Toronto, ON, M5W 1T1 or fax: (416) 701-7022
Account No. |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Amount $__________________
Posting Date ______/______/_______ Transaction Date: ______/______/_______
MM DD YY MM DD YY
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) _________________________________________________________
Signature _________________________________ Date ___________________________
Telephone No. Work (________)_______________________________________________