Submit a request

Please enter your name as it is listed on your account.

Please enter the phone number that is associated with your account.

Did you authorize or participate in this transaction?

Please provide a reason on why you are disputing this transaction.

Was the card PIN memorized only or written down?


Did the customer give another user authorization to use their card?

Please describe in detail what services or merchandise was purchased.

What date did the customer expect their purchase to be delivered?

Was the merchant unable or unwilling to provide service?

Did the customer cancel the merchandise/service prior to the delivery date?

Is this pre-paid merchandise/service where the balance was not paid and the merchant can provide the goods or service?

Was the merchandise delivered late or to the wrong location? If yes, provide more information.

Did the cardholder return the merchandise? If yes, provide the date and return method.

Did the merchant provide return instructions?

Did the cardholder attempt to resolve the matter with the merchant?

Was the cardholder advised of any cancellation policy?

What date was the merchant contacted to cancel the merchandise/service?

Please provide evidence of the cancellation (screenshot or cancellation number).

Please provide more information / reasoning on the cancellation.

Provide more information on how the cardholder attempted to resolve with merchant, including date, who they spoke with and contact method.

What was the amount the customer attempted to withdraw?

What was the amount of cash received during the withdrawal?

Did it take multiple attempts to withdraw cash? If so, what attempt was the cash received on?

What date did the disputed transaction occur?

What amount did the transaction post for? Please provide a copy of receipt.

How was the goods or services purchased?

What was the amount of the second charge on the card?

Describe in detail what was different about the order, including why it was defective or unsuitable the cardholders needs.

What date was the merchandise received?

When was the merchandise returned to the merchant?

Please provide further details around the return attempt to the merchant.

If the merchandise was returned, please provide tracking/shipping info or a credit slip/refund acknowledgement.

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