54.15. A chargeback request must be in writing and contain the following information:(a) the credit cardholder’s name;
(b) the credit card number and expiry date;
(c) the merchant’s name;
(d) the date the contract was entered into;
(e) the amount charged to the credit card account and the sums to be refunded by the merchant;
(f) a description of the goods or services that are the object of the contract and for which chargeback is requested;
(g) the reason for cancelling the contract; and
(h) the date of cancellation and the means used to send the cancellation notice.