HomeMy WebLinkAboutP-card_DisputeJPMorganGhase lj Dispute Form:
This form has been provided for your convenience, If you believe that a tfansactjon on your statement is in error you can use
this form to contact us. Regulations require that you notlry us in writing within 60 days from the statement billing date of the
disputed charge. Any response received after this time frame may resllt in our inability to assist you with your dispute. Please
be advised that Visa & Mastelcard require that aftempts be made to resolve your dispute with th€ melchant
before notifying us. Please complete and mail or fax this form to
Commercial Card Services, ATTN: Dispute Dept., P,O, Box 2015, Elgin, Illinois, 60121-2015, Ccs-Disputes@Chase.com , or
Fax to (447) 931-8a61.
Name:
llerchant Name:
Transaction Date:
Posting Date:
Reference #:
Please Circle OIg ofthe following choices applicable to your dispute, Include A!! necessary information/documentation,
1. I do not recognize the above-mentioned charge. I have attempted to contact the merchant to obtain futher information.
2. I have been billed more than once by the same merchant. I authorized one charge with this merchant only. I\4y card
was in my possession at the time of the transaction,
Transaction Amount: $
\/:lid ah:.na t Darorcn.a "
Invalid Charge $_ Re'erence a
Transaction Date:
Transaction Date:
3. I canceledi Service / Airline'Tlcket / Hotel Reservation on _(date). Cancellation#
4. I have not received the merchandise that was to L€ shiDDed to me on (date). I have requesLed credit.
5. I\4erchandise that was shipped to me arrived damaqed or not as described, I returned it on
and asked the merchant to credit my account. I am providing a copy of my returned mail receipt.
6. IYerchant was to issue credit for merchandise I returned to the store. I have enclosed a copy of my credtt receipt.
7. I have been charged fora purchase that was paid for by other means. Iam providing a copy of the documentation
showing the other method of payment.
(date)
8. I have been billed for an incorred amount. Iqy receipt shows g however, I was billed $
I am providing a copy of my receipt showing the correct amount.
9. I did not authorize the above-mentioned charge. I have aftempted to contact the rnerchant to resolve dispute.
(lf this is a VISA account, Visa regulations require that your account be closed prior to pursu ng lhis dispute reason.
Please aall Customer Service at 800 316-6056 to assisl you in c osing your acaount.)
10. Oll_er: I ar altachilg deta led irforralor t.ar des(. bes rl.e orspute.
Work Phone ( )
Fax
Signature
Email:
Date