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I certify that the charge(s) listed below was (were) not made by either myself or a person authorized by me to use my credit card. |
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My payment did not post. (Please enclose a copy of the front and back of your cancelled check or money order.) |
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The credit did not post to my account.(Please enclose a copy of your credit slip bearing the account number, merchant name, date, and dollar amount.) |
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I was billed twice for a single purchase(Describe the transaction on the reverse of this page.) |
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I did not receive the merchandise.(Describe your attempts to resolve the matter with the merchant, as well as the expected date of delivery on the reverse of this page.) |
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I was overcharged for the purchase.(Please enclose a copy of the signed sales receipt that includes your account number.) |
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The merchant will not give credit.(Please enclose a copy of your sales slip, and original store credit.) Visa/MasterCard regulations prohibit the Service Center from assisting in this dispute if the sales slip reflects IN-STORE CREDIT or NO REFUNDS. |
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I would like a copy of the sales draft.(Describe transaction and reason for your request on the reverse of this page.) |
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I was charged for a hotel room which I cancelled. (Please provide full details on the reverse of this page.) You MUST provide your cancellation number in order for us to process your dispute, or person's name who accepted cancellation. |
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I was charged for the hotel room that I neither made the reservations, nor authorized the reservation to be made for me. |
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My credit posted as a sale.(Describe transaction on the reverse side, and provide a copy of the credit slip, and the date of the original charge.) |
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Merchandise is defective.(Describe on the reverse the defect or damage, attempts to return the merchandise and merchant;s response.) (Shipped merchandise only.) |
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Merchandise has been returned.(Describe on the reverse what was expected and received, reason for return, merchant response and postal receipt or credit slip.) |
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Service.(Membership cancelled.) Please enclose a copy of the letter that was provided to the merchant for cancellation. |
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Service dispute.(Indicate the nature of the dispute and your attempts at resolution.) Dispute must be more than $50 and made within your home state or within 100 miles of your current mailing address. These restrictions do not apply to mail or phone orders disputes. Include copies of all pages of repair bills, contracts or other supporting documentation. |
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Other.(Describe on reverse of page.) Descriptions of transactions should be typed or printed clearly. Attach additional sheets if necessary.
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