Letter Of Dispute Form - Beehive Federal Credit Union

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Letter of Dispute Form
Name: ____________________________________
Address: __________________________________
City, State, Zip: _____________________________
Phone Number: _____________________________
Account Number or Card Number: _________________________
At time of transaction my card was:
in my possession
lost
stolen
Transaction(s):
Date
Merchant
Amount
$
$
$
$
$
Give a detailed explanation of why you are disputing the charge(s) and list what steps have been
taken to resolve the dispute with the merchant:
Please attach any additional information and include copies of any pertinent documentation (receipts,
emails, brochures, tracking numbers, etc.)
Cardholder Signature*____________________________________ Date: ________________
* By signing this Letter of Dispute you hereby acknowledge that you have read and agree to all terms and that all information given
is accurate.
Failure to complete this form in its entirety may cause the dispute to be rejected and the transaction to be represented to your
account. Please allow Mastercard at least 10 business days to begin processing. The entire dispute process may take up to 210
days for domestic disputes and 310 days for international disputes. Please be aware that initial credit is provisional on the decision
of Mastercard or the correction from the merchant and can be recalled at any time.
Revised 9/18/17

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Parent category: Letters
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