![]() ![]() I cancelled this on / / DD MM YYYY I have been overcharged invoice showing the amount you agreed to pay. I have cancelled the regular payment / subscription / membership / annual renewal Please send proof of cancellation where possible for example confirmation from the merchant. Please be sure to send us any documents we require highlighted in blue below copies and photographs are fine. Or if you have more than one tick the boxes that best match each dispute. Transaction date Merchant name as shown on statement amount Disputed amount if different Please provide details of who you contacted when and what happened* Section 3 Which reason best describes your dispute s Please tick the one box that best matches your dispute. ![]() If you run out of space please use Section 4. Please add the transaction s to the table below. Account holder name House name or number Post code Last 4 digits of your account number How can we contact you We ll contact you by post but please let us know if we can also get in touch by phone or email* Telephone number we ll only call between 9am-4pm Email address Section 2 your disputed transaction s. Before we look into your dispute you first need to contact the merchant to see if you can resolve the problem* Section 1 your contact details. Disputed transactions form* Please fill in this form and send us any relevant documents that will help us find out what has happened and try to resolve things for you. ![]() Return Information Please return this completed form along with any supporting documentation to one of the following Post Capital One PO Box 9766 Nottingham NG2 9HY Email UKDisputes capitalone. Then we ll give you an update within 21 days either by letter email or phone. Make sure you have Checked all sections are completed correctly If you complete the form incorrectly or don t provide a detailed explanation where required there may be a delay in processing your dispute Sent us all the documents we ve asked for It may not be possible to help you with your dispute unless all required documents are submitted with the form Complete the signatory box We will review your form and documents to assess what s happened. Date Remember BEFORE YOU SEND US YOUR FORM. That I/we are happy for Capital One to contact the merchant my bank and relevant parties to discuss the dispute disclosing account details and information where needed. ![]()
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