Affidavit of Fraud Notice of Transaction Dispute Card - CAHP: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Cardholder Name and Card Number at the top of the form. Ensure these details are accurate for processing.
In the Transaction Details section, specify the Transaction Amount and Merchant name. If disputing multiple transactions, proceed to page 2.
Complete Section 1 by selecting whether your card is in your possession, lost, or stolen. Provide the date you reported it lost/stolen if applicable.
In Section 2, indicate if you participated in the transaction and provide details regarding any errors, including amounts and receipts as necessary.
For Section 3, describe your dispute with the merchant. Include any relevant dates and proof of cancellation or communication attempts.
Finally, sign and date the form before scanning and emailing it to CardServices@SkyOne.org or faxing it to 310.491.7471.

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