Star One Mobile App

Star One Mobile Banking
It's free and secure to use!

Get the Star One Mobile Banking app for your device.
It's free, intuitive, safe and secure to use!


Cardholder Dispute (Fraud)

For fraudulent use of a credit card, ATM, or debit card.

Form Instructions

To submit this form online, log into Online Banking and locate the form in the "Online Forms" drop-down menu.

Complete, print and sign this form, then mail, deliver, or fax it to:

Star One Credit Union
P.O. Box 3643
Sunnyvale CA 94088-3643
Attn: Card Services
Fax: (408) 543-5203

If you have any questions or concerns, call us and ask to speak with our Card Services Department.

Your Information

Cardholder Name:
Member Number:
Card Number used in transaction:
Primary Contact Phone:
Phone # Type:
Has this loss been reported to police department?
Card Status:
Never Received
In my possession at all times when fraud occurred
Authority contacted:
Were you contacted by our Risk Management Department?

I have examined the charges made to my account and I am disputing the following charge(s) as neither I nor any person authorized by me to use my card, made the charge(s) listed below. In addition, neither I nor anyone authorized by me received goods and services represented by the transaction(s).

Transaction Information:

Merchant Name/Terminal Location Posting Date Amount Disputed
For additional disputed transactions please list below within the "Explain the circumstances surrounding fraud" area. Total Claim $

Explain the circumstances surrounding fraud:

I give my consent to the credit union to release any information regarding my card and/or card account to any local, state and/or federal law enforcement agency so that the information can, if necessary, be used in the investigation and/or prosecution of any person(s) who may be responsible for fraud involving my card and/or card account. Further, I understand I may be required to comply with a court order or subpoena to give testimony. I swear this affidavit is true and understand that making a false sworn statement is subject to federal and/or state statutes and may be punishable by fines and/or imprisonment.

By completing and signing this form, I acknowledge that I have given a correct and true disclosure of the transaction I am disputing. I realize that Star One Credit Union may call upon me to supply additional supporting documentation to strengthen my claim against the merchant. I realize that not providing all details or exact information related to my dispute may delay the dispute resolution process.

Member Signature

Mail this completed form to:
Star One Credit Union
Attn: Card Services
PO Box 3643
Sunnyvale, CA 94088-3643

Or fax to (408) 543-5203
Attn: Card Services