Cardholder Dispute Form Page 2
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2(or attempted to return)
_____ I have returned
merchandise to the merchant. I did not receive a credit slip because
_____________________________________. I was/ was not (circle one) informed of the merchant’s return
policy, and their response to the return was _______________________________.
_____ I cancelled the transaction with the merchant on ________. I was/ was not
(circle one) informed of the
merchant’s cancellation policy, I have contacted the merchant and the response to the cancellation was
_________________________________________________________________________________.
(Please include any contracts or correspondence to and from the merchant,)
_____ I cancelled the hotel reservation on ___________. My cancellation number is _________________.
(If no cancellation number was provided, please provide a telephone statement showing the cancellation call to
the merchant.)
NOTE: Please provide a detailed explanation of the above dispute.
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________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Cardholder Signature __________________________________
Date________________
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Parent category: Financial