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Cardholder Dispute (Fraud)

For fraudulent use of a credit card, ATM, or debit card.

Form Instructions

Complete, print and sign this form, then mail, deliver, or fax it to:

Star One Credit Union
P.O. Box 3643
Sunnyvale CA 94088-3643
Attn: Card Services
Fax: (408) 543-5203

To submit this form electronically, log into Online Banking and select "Cardholder Dispute Form & Affidavit (Fraud)" in the "Forms" menu.

If you have any questions or concerns, call us and ask to speak with our Card Services Department.

Your Information
Email address:
Card Status:
Were you contacted by our Risk Management Department?

I have examined the charges made to my account and I am disputing the following charge(s) as neither I nor any person authorized by me to use my card, made the charge(s) listed below. In addition, neither I nor anyone authorized by me received goods and services represented by the transaction(s).

Transaction Information
Merchant Name/Terminal Location Posting Date Amount Disputed
Total Claim $

Explain the circumstances surrounding the fraud and list any additional disputed transactions:

I give my consent to the credit union to release any information regarding my card and/or card account to any local, state and/or federal law enforcement agency so that the information can, if necessary, be used in the investigation and/or prosecution of any person(s) who may be responsible for fraud involving my card and/or card account. Further, I understand I may be required to comply with a court order or subpoena to give testimony. I swear this affidavit is true and understand that making a false sworn statement is subject to federal and/or state statutes and may be punishable by fines and/or imprisonment.

By completing and signing this form, I acknowledge that I have given a correct and true disclosure of the transaction I am disputing. I realize that Star One Credit Union may call upon me to supply additional supporting documentation to strengthen my claim against the merchant. I realize that not providing all details or exact information related to my dispute may delay the dispute resolution process.

Member Signature

Scam and Fraud Alert

Remember that Star One employees will never call you to verify or ask for your personal information.

Providing your personal information, such as card PINs, online banking credentials or one-time passcodes, to anyone may make you responsible for any fraudulent activity that happens on your Star One accounts.