CARDHOLDER DISPUTE FORM (Non-Fraud)
Complete this form online, PRINT, sign and either mail or fax it to Star One CU. See below.  If you do not recognize a transaction or if your card has been used fraudulently; call Star One Credit Union immediately at (408) 543-5202 or toll free at (866) 543-5202.
Cardholder Name
Date
Member Number
Card Number
Best Contact Phone #
Phone # Type

Transaction Information:
Merchant Name/Terminal Location
Amount
Posting Date
Amount Disputed
I am disputing this transaction for the following reason (please check one):

Although I did participate in a transaction with the merchant, I was billed for transaction(s) totaling $ that I did not, nor any authorized user on my account did not engage in.
(Enclosed is a copy of the authorized sales slip.)

I have not received the merchandise. Expected date of delivery was . I contacted the merchant on (mm/dd/yy), and the merchant's response was .
(In order to assist you, the merchant must be contacted.)
I returned or cancelled the merchandise on (mm/dd/yy) because .
(Please provide a copy of the returned receipt, postal receipt or proof of refund.)
I was issued or promised a credit for $ on (mm/dd/yy), which has not been posted to my account. A copy of my credit slip is enclosed or the name of the phone representative that I spoke to was .
(Please note that merchants must be given 30 days to post the credit to your account before a dispute can be processed.)
Merchandise shipped to me arrived damaged and/or defective on (mm/dd/yy). I returned the merchandise on (mm/dd/yy) and the merchant's response was

(Please provide a copy of the returned receipt, postal receipt or proof of refund.)

My account was charged $ but I should have been billed $ . (Enclosed is a copy of the sales receipt and/or other documents which indicate the correct amount.)
My hotel reservation was cancelled on (mm/dd/yy). The cancellation number provided is .

I was charged twice for the same transaction. The date of the first transaction was (mm/dd/yy).

Other dispute reason or additional information - Attach a letter describing the dispute.


Cardholder Signature X________________________________


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Mail this completed form to: Star One Credit Union, Attn: Card Services, PO Box 3643, Sunnyvale, CA 94088-3643 Fax (408) 543-5203 Attn: Card Services