Cardholder Dispute (Non-Fraud)

You have never received a merchant credit for returned merchandise or cancelled services. You may be asked to provide a credit slip and/or proof of cancellation. Merchants must be given 5 days from the date of return or cancellation to post a credit to your account.

• Returned/Cancellation date:
  mm/dd/yyyy
• What was purchased: merchandise or services?
• Date on credit slip and/or cancellation #
  
• Type of service:

Additional information about promised merchant credit:

You ordered merchandise and/or service that was never delivered/rendered, but your account was charged.

• Expected date of delivery and/or service:
  mm/dd/yyyy
• Did you attempt to resolve transaction with the merchant?
  Yes No
• Date of last contact with merchant was:
  mm/dd/yyyy
  • Name of contact person:
    
  • Method of contact (phone or email):
    
  • What was the merchant's response?
    

Additional information about merchandise/services not received:

You are dissatisfied with the quality or service received, or the merchandise was damaged. Note: You may need to provide supporting documentation as to the nature of the quality of the merchandise or service.

• What was purchased: merchandise or service?
• Describe what was ordered:
  
• Provide details why the merchandise/service were defective/unsuitable:
• What date was the merchandise/service received or expected date to receive the merchandise/service?
  mm/dd/yyyy
• Was the merchandise returned?
  Yes No
• Did you cancel the transaction with the merchant?
  Yes No
  If so, the date of cancellation was: mm/dd/yyyy
• Did you attempt to resolve the transaction with the merchant?
  Yes No
• Date: mm/dd/yyyy
• Name of contact:
  
• Method of contact (phone or email):
  
• What was the merchant's response?
  

• Date of first transaction: mm/dd/yyyy

Provide copies of sales receipts and/or cancelled checks as proof of payment by other means.

The charge on your account is higher than the amount shown on your sales receipt.

• My sales receipt shows this amount:
  
• I have been billed for this amount:
  
  (Please provide a copy of the sales receipt.)

I participated in a transaction with the merchant, but was billed for an additional transaction which I did not authorize.

• Did you attempt to resolve the transaction with the merchant? Yes No
  • Date: mm/dd/yyyy
  • Name of contact
    
  • Method of contact (ie. phone or email):
    
• What was the merchant's response?
  
• Have you received products or services?
  Yes No
  If so, have you returned the products and/or cancelled the services.
  Yes No
  
  Date: mm/dd/yyyy of return or cancellation?

You did not receive all and/or a portion of an ATM withdrawal however it was debited from your account.

• I requested and my account was debited for:
  
• However I only received: