ࡱ> ` +bjbj >>>R    l Rh : : : f NdHJJJJJJ$U h"Fn9>E>n: f 8: >f HH&>: , `JO 4H0,#=`##>pnnRRR RRR RRR  PCard Transaction Dispute Form  After attempts to reach an agreement with the seller have failed the Cardholder should contact the bank at 800.270.7760 to file a formal dispute. Contact should be made within 60 days of the transaction posting date to be considered by the bank. Complete applicable fields below. Submit the completed form to your Independent Reviewer within 48 hours of notifying the bank of the dispute. Cardholder Information (Print or type; all requested information is required.)  FORMTEXT        FORMTEXT        FORMTEXT       Last Name First Name Middle Initial Phone 351-  FORMTEXT       SSU E-mail Address  FORMTEXT       Last 4 Digits of Credit Card #  FORMTEXT       Disputed Transaction Information Merchant Name  FORMTEXT       Transaction Date  FORMTEXT       Transaction Amount $  FORMTEXT       Check the Reason for the Dispute (Select only one explanation below.)  FORMCHECKBOX  I did not make nor authorize the above transaction.  FORMCHECKBOX  There is a difference in the amount I authorized and the amount I was billed.  FORMCHECKBOX  I was previously billed (e.g., double billed) for this transaction. 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FORMCHECKBOX  I have received a credit voucher from the merchant for the above transaction, but it has not yet appeared on my account.  FORMCHECKBOX  The above transaction is mine, but I am disputing due to: (Please explain dispute below, such as merchandise was returned, defective, or not received, or items cancelled with the vendor.)  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