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930/ATG OR P. O. Box 20541 Atlanta GA 30320-2541 OR fax to 404-677-4598 OR email to DeptDisputes Deltacommunitycu. Notification of Disputed Item Form Instructions 4 Mail to Delta Community Credit Union ATTN Disputes Dept. com 1 Complete all applicable fields 2 Print completed form 3 Sign and date the Signature section If you have not done business with the merchant. Contact the Credit Union immediately before proceeding with this form* Visa Regulations require the cardholder to attempt resolution with the merchant prior to filing a dispute. If the merchant is unwilling to resolve the matter satisfactorily please send us a detailed explanation of the merchant s response. Member Information Member Name print Today s Date Visa Card Number Daytime Phone Number Preferred Contact Method Phone Transaction Date Mail Email Dispute Amount Total Transaction Amount Merchant Name Disputed Item Details Check the appropriate box below that most closely matches your dispute type. Return this form and any supporting documents so that your dispute can be processed in a timely manner. Answer all appropriate questions below indicates required fields per dispute type. If any of the below does not accurately reflect your dispute or additional space is needed please write a separate letter and include all of the transaction information listed above. Cancellation/Returned Item Dispute Were you advised of any cancellation/return policy No Yes - If Yes please explain Date of cancellation/return Spoke with Did you cancel this recurring transaction with the merchant Yes Date you cancelled the transaction Describe your attempt to resolve with the merchant Spoke with On date Merchant s Response Processing Error Dispute Were you charged two or more times for the same transaction Date of first charge Date of second charge Date of third charge Date of fourth charge by other means supply a copy of proof of that payment credit posted as a debit Non-Receipt of Goods or Services cash Incorrect must amount copy of their receipt Quality of Services or Goods Dispute difference purchase is unsuitable ordered received defective Please remember to never send confidential information to us via email* Log in to your credit union account and use the Message Center if you need to send sensitive information to us. com 1 Complete all applicable fields 2 Print completed form 3 Sign and date the Signature section If you have not done business with the merchant. Contact the Credit Union immediately before proceeding with this form* Visa Regulations require the cardholder to attempt resolution with the merchant prior to filing a dispute. Contact the Credit Union immediately before proceeding with this form* Visa Regulations require the cardholder to attempt resolution with the merchant prior to filing a dispute. If the merchant is unwilling to resolve the matter satisfactorily please send us a detailed explanation of the merchant s response. If the merchant is unwilling to resolve the matter satisfactorily please send us a detailed explanation of the merchant s response. Member Information Member Name print Today s Date Visa Card Number Daytime Phone Number Preferred Contact Method Phone Transaction Date Mail Email Dispute Amount Total Transaction Amount Merchant Name Disputed Item Details Check the appropriate box below that most closely matches your dispute type.

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