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Reset Form CREDIT CARD CHARGE REQUEST State Form 52371 (R2 / 511) Approved by State Board of Accounts, 2010 INSTRUCTIONS: ELEVATOR/AMUSEMENT DIVISION DEPARTMENT OF HOMELAND SECURITY 302 West Washington
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How to fill out credit card charge request

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How to Fill out a Credit Card Charge Request:

01
Obtain a credit card charge request form from your credit card company or download it from their website.
02
Fill in your personal information, including your name, address, and contact information, in the designated fields.
03
Provide your credit card information, including the card number, expiration date, and security code.
04
Indicate the date and time of the charge you wish to dispute or inquire about.
05
Describe the charge in question in detail, including the merchant's name, the purchase amount, and any additional information that may be relevant.
06
Attach any supporting documentation that substantiates your claim, such as receipts, invoices, or communication with the merchant.
07
Sign and date the credit card charge request form to affirm the accuracy of the information provided.
08
Submit the completed form to your credit card company via mail, fax, or electronic submission, following their specific instructions.

Who Needs a Credit Card Charge Request:

01
Individuals who notice unauthorized or fraudulent charges on their credit card statement.
02
Customers who want to dispute a charge due to unsatisfactory goods or services received.
03
Individuals seeking clarification or documentation regarding a particular charge on their credit card bill.
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A credit card charge request is a formal request made by a cardholder to dispute a charge on their credit card statement.
Any cardholder who notices an unauthorized or incorrect charge on their credit card statement is required to file a credit card charge request.
To fill out a credit card charge request, the cardholder typically needs to contact their credit card issuer either online, over the phone, or through mail, and provide relevant details about the disputed charge.
The purpose of a credit card charge request is to dispute and potentially reverse unauthorized or incorrect charges on a cardholder's credit card statement.
The information that must be reported on a credit card charge request usually includes the cardholder's personal information, details of the disputed charge, and any supporting evidence.
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