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Get LA Commercial Card Claims Statement of Disputed Item

K of America is required, please complete this form, and mail with required enclosures within 60 days from the billing close date to: Bank of America – Commercial Card Services Operations P. O. Box 53142 Phoenix, AZ 85072-3142 FAX (888) 678-6046 Company Name: Account Number: Cardholder Name: This Charge appeared on my statement, billing close date: Transaction Date: Reference Number: Merchant Name/Location: Posted Amount: _______________________ (Cardholder Signature) Disputed Amount: ____.

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