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    Statement of Disputed Credit Transaction

    Uploaded by

    Jonny Rotten
    This document is a statement of disputed credit transaction form for a Chime credit card account. It provides sections for the cardholder to select the reason for disputing a transaction and include relevant details. The reasons include the transaction not being authorized, a duplicate transaction, payment by other means, an incorrect transaction amount, a credit not being processed, non-receipt of goods or services, cancelled goods or services, goods/services not as described, and returned merchandise. It requests information such as dates, transaction references, communication with the merchant, and a signature from the cardholder.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Statement of Disputed Credit Transaction

    Uploaded by

    Jonny Rotten
    64 views2 pages
    This document is a statement of disputed credit transaction form for a Chime credit card account. It provides sections for the cardholder to select the reason for disputing a transaction and include relevant details. The reasons include the transaction not being authorized, a duplicate transaction, payment by other means, an incorrect transaction amount, a credit not being processed, non-receipt of goods or services, cancelled goods or services, goods/services not as described, and returned merchandise. It requests information such as dates, transaction references, communication with the merchant, and a signature from the cardholder.

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    This document is a statement of disputed credit transaction form for a Chime credit card account. It provides sections for the cardholder to select the reason for disputing a transaction and include relevant details. The reasons include the transaction not being authorized, a duplicate transaction, payment by other means, an incorrect transaction amount, a credit not being processed, non-receipt of goods or services, cancelled goods or services, goods/services not as described, and returned merchandise. It requests information such as dates, transaction references, communication with the merchant, and a signature from the cardholder.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    64 views2 pages

    Statement of Disputed Credit Transaction

    Uploaded by

    Jonny Rotten
    This document is a statement of disputed credit transaction form for a Chime credit card account. It provides sections for the cardholder to select the reason for disputing a transaction and include relevant details. The reasons include the transaction not being authorized, a duplicate transaction, payment by other means, an incorrect transaction amount, a credit not being processed, non-receipt of goods or services, cancelled goods or services, goods/services not as described, and returned merchandise. It requests information such as dates, transaction references, communication with the merchant, and a signature from the cardholder.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    CARDMEMBER STATEMENT OF DISPUTED CREDIT TRANSACTION 

    Name : 

    Account Number : 

    Transaction Date : 

    Posted Date : 

    Transaction Description : 

    Please complete only one of the sections below. Use a separate form or additional pages to document each dispute. Once completed, please send this form and any 
    supporting documentation to assist in the investigation to c​ [email protected]. 

    If you have any questions, please contact ​[email protected]​ or 1


    ​ -844-244-6363.  

    ▢ Section 1: Transaction Not Authorized  Yes  No 

    Did you authorize this transaction at the time of purchase? 

    Was your card in your possession at the time of purchase? 

    Did anyone have access to your Chime mobile app?  If ​Yes​, who? 

    Did anyone have access to your credit card?   If ​Yes​, who? 

    Was your phone or other digital wallet lost/stolen?  If ​Yes​, when? 

    Where is your card currently?  In Possession  Lost  Stolen  Not Received 

    Where do you normally store your card? 

    Please provide the date your card left your possession. 

    What was the date of the last transaction the Cardholder authorized? 

    ▢ ​Section 2: Duplicate Transaction


    Please provide the date of the ​duplicate​ transaction. 

    Provide the reference number for the ​authorized​ transaction. 

    ▢ ​Section 3: Paid by Other Means 


    Please provide your alternate form of payment 

    Provide the reference number for the alternate form of payment 

    ▢ ​Section 4: Incorrect Transaction Amount


    What was the amount you were suppose to be charged? 

    Please provide the amount you were charged and enclose a copy of the receipt. 

    ▢ ​Section 5: Credit Not Processed  Yes  No 

    Were you promised a credit back to your payment card?   If ​Yes​, provide ref #. 

    Did the merchant credit you via an alternate payment method?    If ​Yes​, what type? 

    Did the merchant confirm you would receive a credit?   If ​Yes​, when? 

    Please provide the amount you expected to be credited. 

    How did you attempt to contact the merchant?  Phone  Email/Text  In Person  No Attempt 

    If merchant/seller has been contacted, what was their response? 


    ▢ Section 6: Non-Receipt of Goods or Services

    What this for goods or services? ​Please indicate if recurring charge.  Goods  Services  Recurring ▢ 

    Yes  No 

    Did you attempt to resolve this with the merchant directly? 

    How did you attempt to contact the merchant?  Phone  Email/Text  In Person  No Attempt 

    Please provide the date of your last contact with the merchant. 

    When were the goods or services expected to be rendered? ​(Choose One)  Prior to Payment  After Payment 

    Provide the date you expected to receive the goods or services. 

    ▢ Section 7: Cancelled Goods or Services 


    What this for goods or services? ​Please indicate if recurring charge.  Goods  Services  Recurring ▢ 

    Yes  No 
    Did the merchant confirm the cancellation?  

    When did you cancel the goods/services? 

    Please provide a confirmation number associated with the cancellation. 

    How did you attempt to contact the merchant?  Phone  Email/Text  In Person  No Attempt 

    If merchant/seller has been contacted, what was their response? 

    ▢ ​Section 8: Goods/Services Not As Described 


    What this for goods or services? ​Please indicate if recurring charge.  Goods  Services  Recurring ▢ 

    Yes  No 
    Did you receive your purchase at the time of transaction? 

    How did you attempt to contact the merchant?  Phone  Email/Text  In Person  No Attempt 

    Please select the reason services were not as described.  Quality of Purchase  Delivered to Wrong Location 

    Defective Merchandise/Services  Delivered Late 

    False Advertising  Quantity Incorrect 

    Provide more detail if your issue with the goods/services. 

    ▢ ​Section 9: Returned Merchandise 


    Yes  No 
    Did you attempt to return the merchandise?  

    Did the merchant accept your return?   Tracking/Return #:  

    How did you attempt to contact the merchant?  Phone  Email/Text  In Person  No Attempt 

    Please provide the date of your last contact with the merchant. 

    If merchant/seller has been contacted, what was their response? 

    Cardmember Signature:  Date: 

    Contact Number:  
    We will contact you during the hours of 8am - 5 pm CST. 

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