Get Transaction Dispute Form - Optum Bank

The Transaction Dispute Form - Optum Bank is essential for users wishing to dispute charges on their Health Savings Account Debit MasterCard or ACH transactions. This guide provides clear, step-by-step instructions to help users fill out the form correctly and efficiently.

Follow the steps to accurately complete the Transaction Dispute Form.

1. Press the ‘Get Form’ button to access the Transaction Dispute Form and open it for editing.
2. In Part 1, provide your contact information for correspondence. Include your name, address, and a preferred phone number where you can be reached.
3. Proceed to Part 2 to enter your account holder information. Fill in your account holder name, account number, phone number, address, and city/state/ZIP code.
4. If your dispute concerns a debit card transaction, complete Part 3. Record the last four digits of your debit card number. Select either Option A (lost/stolen) or Option B (unauthorized transactions) and provide the necessary details about your dispute.
5. In the explanation section of Part 3, describe how you became aware of the unauthorized activity. List any related transactions by date, amount, and a brief description.
6. If your dispute is related to an ACH transaction, locate Part 4 and complete it instead of Part 3. Fill in the required transaction information and select the reason for your ACH dispute.
7. In Part 5, provide a written statement under penalty of perjury, confirming the accuracy of your claims. Remember to sign and date the document.
8. After completing the form, be sure to attach any supporting documentation necessary for your dispute, such as police reports for lost cards. Finally, you can save changes, download, print, or share the completed form.

Start filling out your Transaction Dispute Form - Optum Bank online today to get your dispute resolved.