Correspondence

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P.O. Box 620002
Internal Mail TX1-2551
Dallas, Texas 75262-9802

CCLTOP

Customer Claim Department
Phone: (866)564-2262
April 13, 2011

Fax: (866)701-9886

SUZY GILLESPIE
107 HEATHER LN
LONGVIEW, TX 75605

Dear SUZY GILLESPIE,
Thank you for notifying us of your recent dispute. We will make every effort to resolve this issue promptly.
In order to expedite your claim, you must complete, sign and return the attached form with the list of disputed
transactions as soon as possible. Please answer all questions and provide specific details.
Please fax or mail the completed form to the fax number or address above. We must receive your response in
order to provide temporary credit.
If your dispute includes a fraudulent transaction, your card will be closed to prevent further unauthorized use.
If you have any questions, please contact a Customer Claim Specialist at the number above and refer to claim
number 173797756950001.
Thank you for choosing Chase.
Sincerely,

Customer Claim Department
JPMorgan Chase Bank, N.A.

173797756950001;1 LCM02_001

7777777707070700077767070635777500757151672655410207322217317401047077622531752254450726627470203771007257366710246333077771707017445000777777707000707007
7777777707070700075353676513544550746277206036711007541573306126623076277437424011130766203554140601307633172203360156077765253775567340777777707000707007
7777777707070700077634215641557550762611164176513207770457115270013071231772772033500743770026732753007247011444237513075352366731767400777777707000707007

Customer Claim Department
Customer Name: SUZY GILLESPIE
Claim Number: 173797756950001
Card Number:
4867940126327676

P.O. Box 620002
Internal Mail TX1-2551
Dallas, Texas 75262-9802
Phone: (866)564-2262 Fax: (866)701-9886

CUSTOMER QUESTIONNAIRE
Please complete this questionnaire and fax it to the number above as soon as possible. If you do
not have access to a fax machine, the form may be mailed to the address above.
Please check the statement that applies to your situation:
My card was lost or stolen.
I have unauthorized transactions, but my card is in my possession. What is the date and amount of the
last valid transaction made with this card ?
I never received this card in the mail
Disputed Transactions:
Tran Date
04/08/2011

Amount Description
$45.22 SALES DRAFT / SHELL OIL 57543262406

Merchant Desc
AUTOMATED FUEL DISPENSERS

Please provide the additional information requested below:
1.
2.

Is the Personal Identification Number (PIN) located with the card, or written down?
Yes
No
If you answered "no" to question 1, do you know of any way someone might have obtained your PIN?
Yes
No If yes please provide details:

3.

Yes
No
Have you ever allowed anyone to use your card?
If so, please identify the individual(s) and circumstance(s).

4.
5.

Yes
No
Do you suspect anyone in particular of using your card?
If you answered "yes" to question 4, please identify the individual and circumstances.

Please attach additional information that may assist in the resolution of your claim.
I certify that the transaction(s) listed were not made by me or by a person authorized to use my card. Additionally, all
transactions after 04/13/2011 without my authorization are fraudulent.
Please sign and date below and provide a daytime phone number. Phone number:

Cardholder's Signature

Date

If you have any questions, please contact a Customer Claim Specialist at the number above and refer to the
claim number.
173797756950001;1 LCM02_001

7777777707070700077767070635777500757151672655410207322217317401047077622531752254450726627470203771007257366710246333077771707017445000777777707000707007
7777777707070700075353676513544550746277206036711007541573306126623076277437424011130766203554140601307633172203360156077765253775567340777777707000707007
7777777707070700077634215641557550762611164176513207770457115270013071231772772033500743770026732753007247011444237513075352366731767400777777707000707007

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