18006005249 2025

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The document is a Chargeback Services Dispute/Fraud Cover Sheet designed for cardholders to report unauthorized transactions or disputes with merchants. It includes sections for personal information, details of the disputed transactions, and various reasons for the dispute. The form also provides instructions for submitting claims and emphasizes the importance of blocking accounts in cases of fraud. Additionally, it contains an affidavit section for reporting fraudulent activity and requires notarization.

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Click ‘Get Form’ to open the Chargeback Services Dispute/Fraud Cover Sheet in the editor.
Begin by filling in your institution's name and contact details, including phone number and today's date. This information is crucial for processing your claim.
Indicate the date the cardholder reported the claim and provide the total number of pages being faxed. Ensure you check only one option regarding the nature of the dispute or fraud claim.
Select a reason for the dispute from the provided options, such as 'No authorization code' or 'Declined authorization.' Be sure to include any relevant details in the explanation field.
List all disputed transactions, including transaction dates, amounts, and merchant names. If there are additional transactions, use the provided sections to document them thoroughly.
Complete the Cardholder Certification section by confirming whether you authorized the transactions and signing where indicated. This step is essential for validating your claim.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Are there consequences for disputing a credit card charge?

Most companies will work with you to try to fix the problem without getting the credit card issuer or payment network involved. But if you are unable to receive a warranted refund or other acceptable resolution from the merchant, a credit card dispute should be your next step.

What is the phone number for United Federal Credit Union?

(888) 982-1400 United Federal Credit Union / Customer service

What happens to the merchant when you dispute a credit card charge?

Disputing a credit card charge does not hurt your credit. However, if the information on your credit report changes because of the dispute, your score may change ingly. Credit agencies can also note the dispute by placing the XB code on your account, which simply means the dispute is under investigation.