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Get PATELCO Credit/Debit Card Transaction Dispute 2012-2024

E the form below. We must receive this form within 60 days of the closing date as printed on your statement. Please fax this form and any supporting documentation to 925.847.3653. Or, send by mail to Patelco at PO Box 2227, Attn: Card Services, Merced, CA 95344-0227. You may also submit this form at any branch. Member Name (             ) (             ) Account Number Merchant Name Member Signature (Required) Date Home Phone Work Phone Transaction Amoun.

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