Skip to content

Application

  • OK Name of person disputing the transaction(s)? is required
  • OK Debit Card Number used in disputing transactions? is required
  • Optional OK Contact number of person disputing the transaction is required
  • Did the cardholder authorize the transaction(s)?

    OK Did the cardholder authorize the transaction(s)? is required
  • When did the cardholder notice the unauthorized transaction(s)

    OK When did the cardholder notice the unauthorized transaction(s) is required
  • Has the cardholder given anyone permission to use their card?

    OK Has the cardholder given anyone permission to use their card? is required
  • OK If Yes, please explain is required
  • Has the cardholder contacted the merchant(s) about the transaction(s)?

    OK Has the cardholder contacted the merchant(s) about the transaction(s)? is required
  • OK If Yes, what was the merchant's response? is required
  • Did the cardholder receive any service or merchandise from the transaction(s)?

    OK Did the cardholder receive any service or merchandise from the transaction(s)? is required
  • OK If Yes, what was received? is required
  • Has the cardholder made any internet purchases in the last six months?

    OK Has the cardholder made any internet purchases in the last six months? is required
  • OK If Yes, please explain is required
  • OK Please explain why you are disputing these transaction(s) is required

Transaction 1

  • Date

    OK Date is required
  • OK Amount is required
  • OK Merchant Name is required

Transaction 2

  • Date

    Optional OK Date is required
  • Optional OK Amount is required
  • Optional OK Merchant Name is required

Transaction 3

  • Date

    Optional OK Date is required
  • Optional OK Amount is required
  • Optional OK Merchant Name is required

Transaction 4

  • Date

    Optional OK Date is required
  • Optional OK Amount is required
  • Optional OK Merchant Name is required

Transaction 5

  • Date

    Optional OK Date is required
  • Optional OK Amount is required
  • Optional OK Merchant Name is required

Transaction 6

  • Date

    Optional OK Date is required
  • Optional OK Amount is required
  • Optional OK Merchant Name is required

Transaction 7

  • Date

    Optional OK Date is required
  • Optional OK Amount is required
  • Optional OK Merchant Name is required

Transaction 8

  • Date

    Optional OK Date is required
  • Optional OK Amount is required
  • Optional OK Merchant Name is required
    By clicking “Submit”, you attest that the transactions detailed above were not made or authorized by you or another person that you authorized to use your card. In addition, you attest that you received no benefit from the transactions being disputed. You give consent to ATCU to release any information regarding your card and/or card account to any federal, state, or local 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 your card. You acknowledge that our investigation process is described fully for your reference in the agreement governing your account, which is available for viewing here: https://www.atcu.com/disclosures.html.
  • OK is required