Notification of Dispute ATM/DEBIT/CREDIT

Notification of Dispute ATM/DEBIT/CREDIT

Member Name

Account Number

ATM Card Number

Transaction Information
(If more than one transaction is in dispute, please provide list specifying the information below for each charge.)

Merchant Name

Location

Transaction Date

Amount

I am disputing the transaction (s) in question because of the following reason(s):

ATM Machine did not dispense cash. Enclosed is a copy of the receipt.

Deposit made was never credited to my account. Enclosed is a copy of the receipt.

Amount credited to my account differs from actual amount of deposit. Enclosed is a copy of the receipt.

The transaction(s) was unauthorized. *No one authorized to use this account signed for or participated in the transaction(s).

*If transaction is unauthorized, please indicate status of card (check one):

Card Lost

Stolen

Card still in account holder’s possession.

If cardholder still in possession of card, is counterfeit card use suspected?

Yes

For mail/phone/e-commerce transaction(s) ONLY: I do not recognize the above- listed transaction despite a good faith effort made to provide me with additional details of the transaction(s).

The charge(s) was paid by another means. Enclosed is a copy of the canceled check or cash/credit receipt.

The amount signed for on the sales draft differs from the amount billed on the monthly statement. Enclosed is a copy of the sales receipt.

The transaction was authorized and then canceled. I have attempted to resolve the dispute with the merchant. A credit voucher was issued (copy enclosed), but the credit has not posted to my account. If no credit voucher was issued, please attach a detailed letter explaining the date and reason for the return.

Cancelled On Date

I have been billed 2 or more times for the same purchase.

Posted On Date

I placed an order with the merchant above. I have not received merchandise which I expected by the date listed below. I have contacted the merchant for credit but no credit has posted to my account.

I expected merchandise on

I contacted the merchant on

I canceled this recurring charge with the merchant. NO charges after this date are authorized from this merchant.

Cancelled Charge on

Cancelled by Phone

Cancelled in Writing

I canceled this reservation

Cancelled Reservation on

Cancelation Number provided to me

I received merchandise different than what I ordered. Attached is a detailed letter explaining what was expected, what was received, and that an attempt to return the merchandise was made.

Describe your dispute

ATTACH COPIES OF ALL RELATED DOCUMENTATION HERE

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

September 28, 2021 12:49 pm PST

Notification of Dispute ATM/DEBIT/CREDIT Uploaded by Samantha Code - [email protected] IP 2600:1700:6180:9f00:d468:b9be:813e:d442

November 28, 2021 10:48 pm PST

California Community Credit Union - [email protected] added by California Community Credit Union - [email protected] as a CC'd Recipient Ip: 67.199.161.80

July 20, 2022 12:06 pm PST

California Community Credit Union - [email protected] added by Adam McGee - [email protected] as a CC'd Recipient Ip: 50.207.9.75

November 10, 2022 1:14 pm PST

California Community Credit Union - [email protected] added by Adam McGee - [email protected] as a CC'd Recipient Ip: 50.207.9.75

October 6, 2025 5:14 am PST

California Community Credit Union - [email protected] added by Samantha Code - [email protected] as a CC'd Recipient Ip: 2600:1700:6180:9f00:d468:b9be:813e:d442