Cardholder Dispute Form (POS) Fraudulent Use of Debit Card PLEASE READ CAREFULLY BEFORE FILLING OUT DISPUTE FORMS Dear Credit Union Member, Attached are the forms required to dispute a Visa/Debit card transaction. Please read this packet carefully and answer all questions as accurate as possible. If your card was lost or stolen and you have any type of fraudulent charges on your account we may ask you to file a police report. In the event we do ask for a copy of the report, please attach it to this packet before returning to the Electronic Services Department. Be sure to provide a detailed explanation on the last page of the dispute packet. Please be aware that by filing this dispute, PCFCU may press charges to the fullest extent of the law. If you are disputing a charge for any other reason, you must first go to the merchant to resolve the matter. If the merchant refuses to resolve the matter, complete this packet and return to the Electronic Services Department. Be sure to provide a detailed explanation on the last page of this packet including names of the person you spoke with, the date, time, and the phone number that you called. We may contact you for additional paperwork. If you are disputing merchandise that was never received or merchandise you returned, the merchant has 30 business days to refund credit. A dispute form can not be filed before the 30 business days. If your transaction was authorized but you later discovered it to be a scam, the credit union may deny your dispute. The Credit Union has 7-10 business days upon receiving your dispute form to issue provisional credit to your account. New Accounts opened within the last 30 days, may take up to 20 days to receive provisional credit. Under Regulation E, you must inform us within two (2) business days after you learn of the loss or theft of your card, to limit your liability to $50.00. * Required Fields Member Account Number: Cardholder Name: Card Number (last 4 digits ONLY): Primary Phone Number: Email Address: Preferred method of contact: Phone Email Was the Merchant contacted: Yes No Were any NSF/Overdraft Fees assessed: Yes No If Yes, what amount: At the time of the disputed transaction(s), my card was: In my possession Never received Lost/Stolen Was Law Enforcement notified: Yes No If Yes, what is the Case Number: Reason for this Dispute: ATM Cash Withdrawal not Received Cancelled Services Merchandise/Service not Received Fraud (call 800-472-3272 immediately to close debit card) Date of Transaction: Date of Transaction: Month Month... January February March April May June July August September October November December / Date of Transaction: Day Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Date of Transaction: Year Year... 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 Amount of Transaction: Merchant Name: Details surrounding the transaction(s): Supporting Documentation (Receipts, cancellation notices, etc.): Member Signature (use mouse or finger): Security Code Go to main navigation