Please fill out the fields in the form below. One of our representatives will contact you if more information is needed to complete the process.

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    Application

    • OKName of person disputing the transaction(s)? is required
    • OKDebit Card Number used in disputing transactions? is required
    • Did the cardholder authorize the transaction(s)?

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

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

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

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

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

      OKHas the cardholder made any internet purchases in the last six months? is required
    • OKIf Yes, please explain is required
    • OKPlease explain why you are disputing these transaction(s) is required

    Transaction 1

    • Date

      OKDate is required
    • OKAmount is required
    • OKMerchant Name is required

    Transaction 2

    • Date

      OptionalOKDate is required
    • OptionalOKAmount is required
    • OptionalOKMerchant Name is required

    Transaction 3

    • Date

      OptionalOKDate is required
    • OptionalOKAmount is required
    • OptionalOKMerchant Name is required

    Transaction 4

    • Date

      OptionalOKDate is required
    • OptionalOKAmount is required
    • OptionalOKMerchant Name is required

    Transaction 5

    • Date

      OptionalOKDate is required
    • OptionalOKAmount is required
    • OptionalOKMerchant Name is required

    Transaction 6

    • Date

      OptionalOKDate is required
    • OptionalOKAmount is required
    • OptionalOKMerchant Name is required

    Transaction 7

    • Date

      OptionalOKDate is required
    • OptionalOKAmount is required
    • OptionalOKMerchant Name is required

    Transaction 8

    • Date

      OptionalOKDate is required
    • OptionalOKAmount is required
    • OptionalOKMerchant 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/home/disclosures.html.
    • OK is required