Dispute Form

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At Southern Security Federal Credit Union, we understand that financial discrepancies can occur. That’s why we’ve designed our comprehensive Dispute Resolution Form to assist our valued members in resolving various types of financial disputes quickly and efficiently. Whether it’s a debit card issue, credit card discrepancy, ACH transaction problem, or ATM dispute, we’re here to help you navigate the process with ease.

Dispute Resolution Form

"*" indicates required fields

Personal Information

First Name*

Last Name*

Phone*

Email*

Card Information

Credit or Debit Card?*

Last 4 Digits of Card*

Was Card Lost or Stolen?*

Would you like to replace your card?*

Dispute Information

Did you participate at all in the transaction?*

Select the reason for the dispute:*

Please give us a detailed reason for disputing the charge.*

Do you physically possess the card at this time?*

Card Expiration Date (If lost, leave blank)

Date of most recent transaction*

How do you suspect your card was wrongfully used?*

Were your card and PIN stored together?*

Have you given anyone else permission to use your card/PIN?*

Have you filed a police report?*

If you were provided a police report number, please share it with us:

Did you attempt to contact the merchant about the charge(s)?*

You should always contact the merchant about a disputed charge first. Can you please provide details on what is hindering your ability to contact the merchant?*

What was the merchant's response?*

Disputed Charge(s)

Date of Disputed Charge #1*

Amount for Dispute #1*

Merchant Name for Dispute #1*

Do you need to dispute a second charge?*

Date of Disputed Charge #2*

Amount for Dispute #2*

Merchant Name for Dispute #2*

Do you need to dispute a third charge?*

Date of Disputed Charge #3*

Amount for Dispute #3*

Merchant Name for Dispute #3*

Do you need to dispute a fourth charge?*

Date of Disputed Charge #4*

Amount for Dispute #4*

Merchant Name for Dispute #4*

Do you need to dispute a fifth charge?*

Date of Disputed Charge #5*

Amount for Dispute #5*

Merchant Name for Dispute #5*

Do you need to dispute a sixth charge?*

Date of Disputed Charge #6*

Amount for Dispute #6*

Merchant Name for Dispute #6*

Do you need to dispute a seventh charge?*

Date of Disputed Charge #7*

Amount for Dispute #7*

Merchant Name for Dispute #7*

Do you need to dispute an eighth charge?*

Date of Disputed Charge #8*

Amount for Dispute #8*

Merchant Name for Dispute #8*

Do you need to dispute a ninth charge?*

Date of Disputed Charge #9*

Amount for Dispute #9*

Merchant Name for Dispute #9*

Do you need to dispute a tenth charge?*

Date of Disputed Charge #10*

Amount for Dispute #10*

Merchant Name for Dispute #10*

Any additional details you think we need to know?

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Created by eBiz Solutions

Effortless checking, maximum benefits

Need new wheels?

A business banking program that works hard for you!

Everything We Do Benefits YOU

Bank on the go.