Dispute Form subnav +

Dispute Form

Non Fraud (Returned goods/Cancelled service)

Please check if all fields are filled correctly

Personal Information

Select Card *

Enter 6 Last Digits (card)*

Name*

Last name*

Phone number*

E-mail*

I.D.*

Dispute Information

Dispute #1

Merchant name as appears on statement*

Amount in dispute*

Transaction date*

Cancellation code (Hotel Reservations - if available)

Date by which the Merchant should have sent the Goods or provided the Service*

Attempt to resolve the dispute with the merchant (attach evidence or contact information)*

Upload Document

Want to add more disputes?

Yes

Dispute #2

Merchant name as appears on statement

Amount in dispute

Transaction date

Cancellation code (Hotel Reservations - if available)

Date by which the Merchant should have sent the Goods or provided the Service

Attempt to resolve the dispute with the merchant (attach evidence or contact information)

Upload Document

Want to add more disputes?

Yes

Dispute #3

Merchant name as appears on statement

Amount in dispute

Transaction date

Cancellation code (Hotel Reservations - if available)

Date by which the Merchant should have sent the Goods or provided the Service

Attempt to resolve the dispute with the merchant (attach evidence or contact information)

Upload Document

Want to add more disputes?

Yes

Dispute #4

Merchant name as appears on statement

Amount in dispute

Transaction date

Cancellation code (Hotel Reservations - if available)

Date by which the Merchant should have sent the Goods or provided the Service

Attempt to resolve the dispute with the merchant (attach evidence or contact information)

Upload Document

Want to add more disputes?

Yes

Dispute #5

Merchant name as appears on statement

Amount in dispute

Transaction date

Cancellation code (Hotel Reservations - if available)

Date by which the Merchant should have sent the Goods or provided the Service

Attempt to resolve the dispute with the merchant (attach evidence or contact information)

Upload Document

Notes

Please provide as many evidence as possible by uploading all your documents as this will speed up the Dispute process.

When you have filled in all the appropriate fields of the form, Click on the SUBMIT button below. Thank You!

I acknowledge being informed of the investigation fee, ($ 10.50) which will be automatically charged to my account when confirmed that the transaction(s) belong(s) to me. *