Cardholder Dispute Form (ATM and Debit Cards)

To place a cardholder dispute request, please submit your request through a letter, a fax, bring it in, or drop it in the night drop.

You can download the form to submit your request!

Cardholder Dispute Form (Adobe Acrobat .pdf format)

To open this Application, you will need the Adobe Acrobat Reader.

We’ll need the following information:

  1. Member Account Number
  2. Primary member’s Name
  3. Card Number
  4. Address
  5. Home and Work Phone Number
  6. Transaction Date
  7. Transaction Amount
  8. Merchant/Location of Transaction
  9. Detailed statement describing the transaction and if the transaction is fraudulent
  10. Signature (Mandatory)

You can download the form to submit your request!

Cardholder Dispute Form (Adobe Acrobat .pdf format)

Please, contact our Member Services Officer at 404-525-0619 ext. 219 for more details.

NCUA Logo         Equal Housing Opportunity logo         Privacy Statement