Visa Debit Card Dispute Form - Us Postal Service Page 2
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2___ Returned Merchandise Dispute/Credit Not Received
* Date Account was Debited for Merchandise: ________________________
* Date Merchant was First Contacted: __________________ * Date Merchandise Returned: ____________________
* Describe your a empt to resolve the ma er with the merchant:
___________________________________________________________________________________________________
___ I Was Charged Two or More Times for the Same Transac on
* Date of first charge: ________________________ * Date of second charge: ______________________________
Date of th rd charge:
_________________________ Date o fo r h charge: _______________________________
* Describe your a empt to resolve the ma er with the merchant:
___________________________________________________________________________________________________
___ I Paid for These Goods or Services by Other Means
* ___ Check ___ Cash ___ Other Bank Card ___ Other: _________________________________________
* Describe your a empt to resolve the ma er with the merchant:
___________________________________________________________________________________________________
Note: If selec ng this dispute reason, you must supply a coy of proof of your other means of payment.
___ Non‐Receipt of Goods or Services
* Select One: ___ Merchandise not Received ___ Service not Received
* What service or merchandise was ordered? _____________________________________________________________
* I expected delivery/services on (date): ___________________________
* Merchant unwilling or unable to provide service? ___ No ___ Yes
If yes, please explain: ________________________________________________________________________
* Describe your a empt to resolve the ma er with the merchant:
___________________________________________________________________________________________________
___ Incorrect Transac on Amount
* This transac on posted for $ __________________ but should have posted for $ ________________________.
(Please supply a copy of your receipt.)
* Describe your a empt to resolve this dispute with the merchant:
___________________________________________________________________________________________________
Please PRINT and SIGN this form.
Return this form to any USPS FCU branch loca on, or mail it to
(Signature line is on page 1.)
USPS FCU VISA Dept. 7905 Malcolm RD, STE 311 Clinton, MD 20735, or fax the form to USPS FCU VISA Dept. at 301‐856‐4409.
Card Number: __________________________________________
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