Cardholder Credit & Debit Dispute/Fraud

Cardholder Credit & Debit Dispute/Fraud

Directions: Completely fill out and submit this form. If you prefer fax or email a PDF version of this form, click here to Download/Print a PDF.

Disputes must be filed within 90 days of the transaction posting.







Transactions to Dispute

You may dispute up to 3 transactions on this form.











Please complete the section below that best describes the reason for submitting this claim.
• If FRAUD, please fill out a reason from the “Fraud Reasons” section.
• Or, if this is a MERCHANT DISPUTE, please fill out a reason from the “Dispute Reasons” section.
You may be contacted by the institution to obtain additional information. Failure to respond may result in your claim being denied.

FRAUD REASONS: Please note that in all cases of FRAUD, card will be closed immediately, and a new card will be issued.

 
– My card was:

In my possession
Lost
Stolen
 

DISPUTE REASONS: Before disputing charges, please make every effort to resolve with the merchant.


 



















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