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Cardholder Dispute (Non-Fraud)

Use this form to dispute transactions for various reasons.

Form Instructions

Select the situation on this form that describes your situation. Additional information may be requested. You must complete all required fields.

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 (Non-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

Date:
Posting Date: mm/dd/yyyy
Amount Disputed:

I am disputing this transaction for the following reason:

You ordered merchandise and/or service that was never delivered/rendered, but your account was charged.

  • Expected date of delivery and/or service:
    mm/dd/yyyy
  • Did you attempt to resolve transaction with the merchant?

  • mm/dd/yyyy


Additional information about merchandise/services not received:

You are dissatisfied with the quality or service received, or the merchandise was damaged. Note: You may need to provide supporting documentation as to the nature of the quality of the merchandise or service.

  • What was purchased: merchandise or service?

  • Provide details why the merchandise/service were defective/unsuitable:

  • mm/dd/yyyy
  • Was the merchandise returned?
  • Did you cancel the transaction with the merchant?

  • Did you attempt to resolve the transaction with the merchant?
    Yes No
Additional information about quality dissatisfaction:
  • mm/dd/yyyy
Additional information on being charged twice:

Provide copies of sales receipts and/or cancelled checks as proof of payment by other means.

Additional information about other payments:

The charge on your account is higher than the amount shown on your sales receipt.




  • (Please provide a copy of the sales receipt.)
Additional information on overcharge:

I participated in a transaction with the merchant, but was billed for an additional transaction which I did not authorize.

  • Did you attempt to resolve the transaction with the merchant?

  • Have you received products or services?
Additional information about unauthorized transaction:

You did not receive all and/or a portion of an ATM withdrawal however it was debited from your account.



Additional information about incorrect currency dispensed from an ATM:
Please explain in detail the nature of your dispute.

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
_______________________
Date