ATM/Debit Card Dispute

ATM Card Only
If you are needing to file a dispute on a debit or credit card, for fraud or non-fraud transactions call: 1-833-809-9996
List transaction details below. To add additional lines, press the + at the end of a row.
List transaction details below. To add additional lines, press the + at the end of a row.
Date Description Amount
Please describe in detail why you are disputing these transactions:
What steps, if any, have you taken to resolve this issue with the merchant? Please describe:
ATM Card Number
Is this card in your possession?
- Yes
- No
*Note: Please attach any proof of return, written correspondence between you and the merchant or any other helpful information to support your claim.
Max. file size: 300 MB.
By signing below, I certify that the above information is true and accurate. For fraudulent transaction, I further certify that the above was not authorized by me nor did I authorize any other individual to conduct the activity with my ATM/debit card.
By signing below, I certify that the above information is true and accurate. For fraudulent transaction, I further certify that the above was not authorized by me nor did I authorize any other individual to conduct the activity with my ATM/debit card.
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Date	Description	Amount

ATM Card Only