Chargeback Request to Bank (Card Payment)

Subject: Chargeback request – Card payment dispute – [Merchant name] – £[Amount]

To: [Bank name] – Disputes/Chargebacks Team
Email/Post/Secure Message: [Where you are sending this]
Date: [DD Month YYYY]

Dear [Bank name] Disputes Team,

I am requesting that you raise a chargeback for the following card transaction:

Merchant name: [Merchant name]
Transaction date: [DD Month YYYY]
Amount: £[Amount]
Card type: [Visa/Mastercard/Amex]
Last 4 digits of card: [1234]
Transaction reference (if shown): [Reference]

Reason for chargeback: [Goods not received / Service not provided / Cancelled service / Faulty goods / Duplicate charge / Unauthorised transaction]

What happened

• [Brief timeline of events – order date, expected delivery/service date, what went wrong]
• [What you have done to resolve it with the merchant – emails, chats, return attempts]
• [Merchant response (if any) – refused refund / no reply / misleading information]

What I want

Please raise a chargeback for £[Amount] and confirm the reference number and next steps.

Evidence available

• [Order confirmation / invoice / receipt]
• [Screenshots of merchant communications]
• [Delivery tracking showing not delivered / return proof / cancellation confirmation]
• [Photos/video of faulty/damaged goods (if relevant)]
• [Any other relevant documents]

If you require any additional information or forms completed to progress this request, please let me know exactly what is needed.

Yours faithfully,
[Your full name]
[Your address (if needed)]
[Your phone number]
[Your email address]