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Customer Statement of Dispute		Date________________________

Note: Failure to provide adequate information may affect your dispute rights and processing time. Depending on the documentation required a dispute may take up to 60 days to process. Please be as complete and specific as possible.

Please use only one form for each charge disputed. (You may make copies of this form)

NAME__________________________________________________	ACCOUNT #______________________________________________
SIGNATURE_____________________________________________	EMAIL ADDRESS_________________________________________
REQUIRED
DATE OF CHARGE_______________________________________	MERCHANT NAME_______________________________________
AMOUNT OF CHARGE____________________________________	AMOUNT DISPUTED______________________________________

PHONE # (TO BE REACHED AT BETWEEN 7 AM AND 5:30 PM CT)___________________________________________________________

Please check and complete the information for the category that best applies. Additional information can be noted on the back of this form. Cancellation/Returns—I have returned the merchandise or cancelled merchandise or services and have not received credit

What was purchased? (Please be specific)____________________________________________________________________________________

Were you advised of Merchant’s cancellation or refund policy at the time of purchase? ___Yes* ___No *Please explain policy on back of this form.

Date of cancellation___________________________________	Who you spoke with ______________________________________________
Cancellation#________________________________________	Reason for cancellation_____________________________________________
Date Returned_______________________________________	Shipping Company & shipping/tracking #______________________________
Date attempted to resolve with merchant__________________	Who you spoke with _______________________________________________

Merchant’s response______________________________________________________________________________________________________

Quality of Merchandise/Services--*Describe the difference between what was ordered and what was received. What was defective or why the purchase is unsuitable for your needs? YOU MAY BE CONTACTED FOR ADDITONAL INFORMATION (please use additional space on back of this form if needed)

_______________________________________________________________________________________________________________________

Date of cancellation___________________________________	Who you spoke with______________________________________________
Cancellation#________________________________________	Reason for cancellation____________________________________________
Date Returned_______________________________________	Shipping Company & shipping/tracking #_____________________________
Date attempted to resolve with merchant__________________	Who you spoke with _____________________________________________

Merchant’s response____________________________________________________________________________________________________

Non-receipt of Merchandise/Services—I did not receive the purchased services or shipped merchandise


What was purchased? (please be specific)___________________________________________		Expected date of delivery_________________
Date attempted to resolve with merchant__________________	Who you spoke with_______________________________________________

Merchant’s response_____________________________________________________________________________________________________

Transaction Errors

___I have been billed more than once for the same purchase. The original charge posted on __________________________________________

___Incorrect amount posted to my account.

Enclosed is a copy of my receipt for $_____________, but the charge posted to my account as $______________.

Unauthorized Charge *SIGNATURE ABOVE IS REQUIRED*

I did not authorize or participate in this transaction.

as lost or stolen upon return of this dispute form.

I understand that by stating the charge is unauthorized that this account will be closed and reported A new account may be issued at the discretion of World’s Foremost Bank.

Charge Not Recognized

I do not recognize the transaction and require additional information to enable me to successfully identify the transaction or merchant. I attempted to identify the charge with the merchant on (date). ___________________

WFB Visa Center * Attn: Customer Service/Disputes * PO Box 82608 * Lincoln, NE 68501-2608 Fax 402-323-4497

Revised Feb 10!

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_________________________________________________________________________________________________________________________

WFB Visa Center * Attn: Customer Service/Disputes * PO Box 82608 * Lincoln, NE 68501-2608 Fax 402-323-4497

Revised Feb 10

Question	Answer
Form Name	Customer Statement Of Dispute Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	cabela's visa login, cabela's dispute form, cabela's club visa, cabela's club visa sign in

Customer Statement Of Dispute Form – Fill Out and Use This PDF

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