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.
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
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