Visa Debit and Credit Card Dispute

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Visa Debit Card Dispute

Please complete and submit this form for all SECU debit card dispute claims. For credit card dispute claims, please call 800-344-6501 to submit your claim. Fields marked with an asterisk (*) are required.

Name*

First Name

Last Name

Member Number*

Last Four Digits of Card Number*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number*

Email*

How many fraudulent/unauthorized transaction(s) are you submitting?*

Transaction Date*

Transaction Amount*

Dispute Amount*

Merchant Name*

If you have multiple items that you are disputing, please check only one statement below that pertains to the first dispute claim being filed and provide the information requested. Then list additional disputes in the Additional Information section and provide the requested information. *

Incorrect Amount (I was billed the wrong amount.) Duplicate Charge (I have been billed more than once for the same transaction.) Paid By Other Means (I paid for this transaction via another payment method or credit card.) Cancelled Transaction (I was charged for something I previously cancelled.) Merchandise/Service Not As Described (The merchandise/service I received was damaged, defective, or not what I expected.) Credit Not Received (I have not been credited for the merchandise I returned.) Non-Receipt Of Merchandise Or Service (I did not receive the merchandise or service I ordered by the agreed upon date.)

Please describe your attempt to resolve this dispute with the merchant below*

What was the amount you should have been billed?*

Please attach your receipt. *

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Please provide a copy of the statement and identify which charge is valid and which is a duplicate. *

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Paid By: (select one)

Check Cash Another Credit Card Other

Please describe your attempt to resolve this dispute with the merchant below *

Please provide a copy of your cash receipt, the front and back of your cancelled check or a copy of your statement if another credit card was used. *

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Date of cancellation*

Were you advised of the merchant’s cancellation policy? (Yes or No)

If yes, how were you advised?

What was your method of cancellation? (select one)*

Phone Mail Email In Person

Cancellation number and/or name of person you spoke with*

Please describe your attempt to resolve this dispute with the merchant and your reasons for cancellation below*

If you cancelled by phone, please provide a copy of the telephone bill reflecting the call if available. If you cancelled by email, please provide a copy of the email correspondence. *

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What was purchased? *

Date the merchandise/service was received*

Date you returned the merchandise or made it available for pick up (if applicable)

Return authorization, cancellation and/or tracking number (if available)

Please describe your attempt to resolve this dispute with the merchant for merchandise/services not as described below*

What was purchased? *

Date the merchandise/service was received *

Date you returned the merchandise or made it available for pick up (if applicable)

Reason for returning the merchandise*

Return authorization, cancellation and/or tracking number (if available)

Please describe your attempt to resolve this dispute with the merchant below*

Please provide a copy of the credit slip, return receipt or proof of return, such as a postal receipt and any documentation you have that supports your claim*

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What was purchased? *

Date you expected to receive the merchandise or service*

If merchandise, was it to be shipped or picked up? (select one)*

Please describe your attempt to resolve this dispute with the merchant below.*

Additional Information: Use this space to list and provide information about additional disputes.

Supporting Documents

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Please allow three business days from the receipt of this completed document for us to begin processing. The length of the entire dispute process will vary based on the complexity of your claim.

Acknowledgement:*

I confirm the information contained in this document is truthful. I acknowledge SECU may release the information contained herein to law enforcement officials for investigative purposes.