Cardholder Dispute Form (Non-Fraud)

Dispute/Charge Error

A dispute/charge error is a transaction you may recognize but appears incorrect.  Some common examples of disputed transactions include:

  • A recurring transaction or trial subscription that you had canceled.
  • The product or service was never received or received late.
  • You are dissatisfied with the product or service.
  • You returned or canceled the purchase, but still have not received credit.
  • The amount charged is higher than the amount on the receipt.
  • The same card was charged multiple times for the same transaction.
  • Your card was charged even though a different card or payment method was used.
In most cases, the quickest way to resolve a dispute is by contacting the merchant first. As we may require documentation and additional information from you and the merchant to process a claim, contacting the merchant directly may save you time.
  • Merchant Name is a required field
  • Merchant Contact Date is a required field
  • Merchant Phone Number (Enter N/A if not applicable) is a required field
  • In detail, please describe your attempt to resolve the matter with the merchant the result* is a required field
    • Please provide supporting documentation (e.g., emails, receipts, invoices, etc.) is a required field
    • Cardholder Name is a required field
    • Member, Account, or MICR Number is a required field
    • Primary Contact Phone is a required field
    • Email is a required field
    • Amount Disputed is a required field
    • Member Discovery Date is a required field
    • Card Number used in transaction is a required field
    • Phone Number Type is a required field
    • Posting Date is a required field
    • Please indicate card type is a required field
    • I am disputing this transaction for the following reason: is a required field
    By completing and signing this form, I acknowledge that I have given a correct and true disclosure of the transaction I am disputing. I realize that Monterra Credit Union may call upon me to supply additional supporting documentation to strengthen my claim against the merchant. I realize that not providing all details or exact information related to my dispute may delay the dispute resolution process.
    • reCAPTCHA is a required field