Customer Statement Of Dispute Form PDF Details

When you make a purchase, the last thing you want to worry about is a dispute with the seller. Unfortunately, disputes happen occasionally. If you need to dispute a charge on your credit card, it's important to understand the process and complete the proper form. This blog post will walk you through the steps of disputing a charge on your credit card and provide a link to download the customer statement of dispute form.

QuestionAnswer
Form NameCustomer Statement Of Dispute Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescabela's visa login, cabela's dispute form, cabela's club visa, cabela's club visa sign in

Form Preview Example

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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