Travel/Corporate Card Dispute Form

Regulations regarding your dispute require that you notify JPMorgan Chase in writing within 60 days of your receipt of the statement reflecting the disputed charge. You are not required to use this form to notify them of your dispute, you may write them a separate letter. Attempts should be made with the merchant to resolve the dispute before notifying your credit card company. Any response received after the above mentioned time frame may result in the credit card company's inability to assist you with your dispute.

Please enter the information below, then select the "Printable Form" button which will return a page which is your Dispute Notification Form. Print the form, sign it, and fax your dispute notification to (801) 590-1316.

General Information
Name:		Email:
Account Number:
Merchant Name:		Amount:
Transaction Date:	/ /	Post Date:	/ /

I have contacted the merchant in an attempt to resolve my dispute, but continue to dispute the above charge for the following reason:
	I have been billed more than once by the same merchant. I authorized one charge with this merchant for $ on the date , but I did not make or authorize $ on the date . My credit card was in my possession at the time of this transaction.
	I have been charged for a purchase that was paid for by other means. (Other credit card, Check, Etc.) Enclose copy of other method of payment that verifies purchase was paid for by other means.
	I have been billed for the wrong amount on my account. My credit card receipt shows $ . However, I was billed $ . Enclose a copy of receipt showing correct amount.
	I did not authorize this charge.
	Merchant was to issue credit for goods returned on the date . This credit has not posted to my account. Enclose copy of credit receipt received from merchant/or copy of returned mail receipt.
	I have not received the Services/Merchandise I ordered. The Service/Delivery date was . Explain all details, including your attempt to resolve with the merchant.
	I attempted to return merchandise but the merchant refuses to accept it. Explain reason for return, Give Merchant’s response and provide copy of original return mail receipt.
	I Canceled : Service, Airline Ticket, Hotel Reservation, on the date . Cancellation # .
	I have contacted the merchant to resolve my dispute about the quality of services or goods and am still not satisfied. Describe dispute fully, in detail. Include all documentation that supports your claim.
	I have resolved my dispute with the merchant.

Requisitioner's signature: ______________________________________ Date: _____/_____/_____

MS#1 • Woods Hole, MA 02543 • 508.289.2371 • Fax 508.457.2192 • procurement@whoi.edu

Last updated: April 1, 2013

Copyright ©2007 Woods Hole Oceanographic Institution, All Rights Reserved, Privacy Policy.
Problems or questions about the site, please contact webdev@whoi.edu
Contact Us | WHOI.edu Internal | Site Map | WHOI.edu External