Transaction Dispute Form

User Guide: Transaction Dispute Form

This user guide will help you complete the Transaction Dispute Form correctly and efficiently.

Overview

The Transaction Dispute Form allows you to formally challenge unauthorized or incorrect transactions on your account. Complete this form accurately to help your financial institution investigate and resolve your dispute.

How to Complete the Form

Section 1: Personal Information

• Full Name: Enter your complete legal name as it appears on your account
• Account Number: Provide your bank/credit card account number
• Email Address: Enter a valid email where you can be contacted
• Phone Number: Provide a contact number where you can be reached
• Address: Enter your complete street address, city, state, and ZIP/postal code

Section 2: Transaction Details

• Transaction Date: Select the date when the disputed transaction occurred
• Dispute Amount: Enter the exact amount you're disputing
• Merchant Name: Provide the name of the business where the transaction occurred
• Transaction ID: Enter the reference number for this transaction (found on your statement)
• Transaction Description: Briefly describe what the transaction should have been for

Section 3: Reason for Dispute

• Select the most appropriate reason for your dispute:
  • Unauthorized transaction: You didn't authorize this charge
  • Duplicate processing: You were charged multiple times for the same thing
  • Incorrect amount: The charged amount differs from what was agreed
  • Goods/services not received: You paid but never received what you bought
  • Defective or not as described: The received item was defective or different than described
  • Cancelled transaction: You cancelled but were still charged
• Dispute Details: Provide a clear, chronological explanation of what happened
• Desired Resolution: Select what outcome you're seeking

Section 4: Supporting Documentation

• Check all types of documentation you're including with your dispute
• Provide details about your supporting documents in the text box

Section 5: Declaration

• Read the declaration carefully
• Check the box to confirm the information is accurate
• Provide your signature and the current date

Before Submitting

1. Double-check all information for accuracy
2. Ensure you've included all required supporting documents
3. Keep a copy of the completed form for your records
4. Print the form if needed using the "Print Form" button

Submission Instructions

Submit the completed form along with copies (not originals) of your supporting documentation to your financial institution using one of these methods:

• In person at a branch
• By mail to the address provided by your institution
• Through secure online messaging in your banking portal

Important Notes

• Submit your dispute as soon as you identify an issue
• You typically have 60 days from the statement date to dispute a transaction
• Your financial institution may provisionally credit your account during investigation
• The dispute process can take up to 45-90 days to resolve
• Always monitor your account statements regularly

Getting Help

If you need assistance completing this form, contact your financial institution's customer service using the phone number on the back of your card.

Security Tips

• Never email completed forms with personal information
• Use secure methods to submit your dispute
• Keep copies of all correspondence related to your dispute
• Shred any drafts or unused copies of the form

By following this guide, you'll ensure your dispute is processed efficiently and effectively.