Secure Form – Authorized Card Transaction Dispute



This form can be custom made for your credit union or used as-is. It can be embedded in your credit union website, mobile app or even It’s Me 247 Online Banking (desktop). Member submissions to these forms are secured in the CU Publisher Request Center. An email will be sent that a member has submitted this request. It is then your credit union’s staff’s responsibility to log in to Request Center to vet and fulfill the request per your procedures.



  • Transaction Information: Please complete a separate form for each disputed transaction.

  • MM slash DD slash YYYY
    Please note: It is the member’s responsibility to contact the merchant and attempt to resolve your dispute. If you are unsatisfied with the results of your attempt/s to resolve the issue, we may dispute the charge on your behalf. You must provide the Credit Union with a detailed letter explaining what attempts were made to resolve this issue and any supporting documentation you have to support your dispute.
  • Drop files here or
    Accepted file types: png, jpg, jpeg, Max. file size: 3 MB.
    • Drop files here or
      Accepted file types: pdf, docx, doc, odt, rtf, txt, Max. file size: 3 MB.
        The Credit Union will research the transaction on your behalf and submit the dispute to our card processor for processing. In some instances, we may require a live signature and additional forms to complete the dispute process. We will deliver these additional forms to the email address you provide below.