Secure Form – Unauthorized Card Transaction Dispute

$0.00

 

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.

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Description

  • UNAUTHORIZED CARD TRANSACTION DISPUTE

  • Transaction Information: Please complete a separate form for each disputed transaction.
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  • Affidavit: I submit this dispute to report the unauthorized and fraudulent use of my credit or debit card. I did not give, sell or trade my credit or debit card to anyone nor give anyone permission to use my credit or debit card. I did not receive any benefit from the unauthorized use of my credit or debit card. I have never shared my credit or debit card or PIN with anyone and have never authorized anyone to use my credit or debit card.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
    Please note, this form will alert the Credit Union that you are disputing a transaction processed with your credit or debit card. If you are disputing multiple transactions, you must complete one dispute form for each disputed transaction. 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.
  • Accepted file types: png, jpg, jpeg, Max. file size: 3 MB.
  • Accepted file types: pdf, docx, doc, odt, rtf, txt, Max. file size: 3 MB.

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