Submit a Debit Card Dispute

Use this form to submit a claim for any charges on a card that the cardholder would like to dispute.
Prior to disputing charge(s), you must make every effort to resolve the dispute with the merchant.

Your Information



Merchant Information

Prior to disputing charge(s), you must make every effort to resolve the dispute with the merchant.

Dispute Details

Cardholder did not authorize or participate in this transaction(s).

Cardholder must contact the merchant prior to disputing the charge, and must provide proof of cancellation within the free trial period.
Cardholder must attempt to contact the merchant prior to disputing this charge.


Cardholder must attempt to contact the merchant prior to disputing the charge. Only one transaction is valid but posted more than once. All cards issued to the cardholder are in their possession.














Cardholder must attempt to return the merchandise prior to exercising this right. Please attach signed proof of return, credit slip or postal receipt to your reply email.














You must attempt to contact the merchant prior to disputing the charge.






Please check your email inbox for a confirmation message. Please respond directly to that message with any relevant attachments.

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