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Cardholder Dispute (Non-Fraud)

Use this form to dispute transactions for various reasons.

Form Instructions

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


Click on the button that describes your situation. Additional information may be requested. You must complete all required fields shown beneath your question.

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

Member Name:
Member Number:
Today's date:
Card Number used in transaction:
Provide best contact option:
Merchant Name/Terminal Location:
Posting Date: mm/dd/yyyy
Amount Disputed:

I am disputing this transaction for the following reason:

Please select one of the following options.

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: or ?
  • Date on credit slip and/or cancellation #
  • Type of service:

Additional Information:

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?
  • Date of last contact with merchant was:
    mm/dd/yyyy
    • Name of contact person:
    • Method of contact (ie. phone or email):
    • What was the merchant's response?

Additional Information:

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?
  • Did you cancel the transaction with the merchant?

  • Did you attempt to resolve the transaction with the merchant?

Additional Information:

  • Date of first transaction: mm/dd/yyyy

Additional Information:

(i.e. cash, check, other credit card, etc). Provide copies of sales receipts and/or cancelled checks as proof of payment by other means.

Additional Information:

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

  • My sales receipt shows:
  • I have been billed for:

    (Please provide a copy of the sales receipt.)

Additional Information:

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?
  • What was the merchant's response?
  • Have you received products or services?

Additional Information:

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:

Additional Information:

Please explain in detail the nature of your dispute.


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
_______________________
Date