NOTIFICATION OF DISPUTED AUTHORIZED MASTERCARD DEBIT TRANSACTION
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Transaction Information: Please complete a separate form for each disputed transaction.
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I certify that the transaction was authorized, however I’m disputing the transaction because ONE of the following:
  • The merchant charged me card twice on the same day for the same item.
  • The charge was paid by another means.
  • I cancelled this transaction with the merchant.
  • I ordered merchandise from the merchant, however the merchandise never arrived.
  • I cancelled a reservation.
  • I cancelled this recurring charge with the merchant. However, merchant continues to bill me after my cancellation.
  • I received merchandise/services different from what I requested/authorized.
Please note: It is the member’s responsibility to contact the merchant and attempt to resolve your dispute. If you are unsatisfied with the results of your attempt/s to resolve the issue, we may dispute the charge on your behalf. You must provide the Credit Union with a detailed letter explaining what attempts were made to resolve this issue and any supporting documentation you have to support your dispute.
Upload images of all related documentation to this dispute.

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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.
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Thank You, we will be in touch with any further questions.