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Which of the following would you like to report?

I participated in this transaction, but there is a problem.

Which of the following best describes the reason for your dispute?

 I have not received the merchandise or services that I purchased.

...

...

titleMerchandise or Service Not Received

Question

...

Type

Values

Mandatory/Optional/Conditional

Notes

Are you disputing the full amount of the transaction?

...

Merchandise,

Service

Yes/No

Mandatory

What amount are you disputing?

Freeform Text

Conditional

When “Yes” to “Are you disputing the full amount of the transaction?”

Why is the dispute different than the posted transaction amount?

Freeform Text

Conditional

Follows “What amount are you disputing?”

Is the purchase a third-party gift card without an expiration date, where the merchandise or services were not provided by the third party due to insolvency or bankruptcy?

...

Yes/No

Mandatory

What was not received?

Single Select

Merchandise

Service

Mandatory

Please provide a detailed description of what was purchased and an explanation of the dispute.

Freeform Text

Mandatory

Merchandise

Question

Type

Values

Mandatory/Optional/Conditional

Notes

Did the merchant cancel the merchandise?

Yes/No

Mandatory

Date merchant cancelled merchandise

Date

Conditional

When “Yes” to “Did the merchant cancel the merchandise?”

Is the merchant in bankruptcy or liquidation?

Yes/No

Mandatory

Are you still expecting a delivery for the merchandise?

Yes/No

Mandatory

What is the last expected receipt date for the merchandise?

Date

Mandatory

Why are you initiating a dispute prior to the expected delivery date?

Freeform Text

Conditional

When “Yes” to “Are you still expecting a delivery for the merchandise?”

What was the expected receipt time for the merchandise?

Freeform Text

Mandatory

Was the merchandise delivered to the incorrect location?

Yes/No

Mandatory

Please provide the address of the agreed upon location.

Freeform Text

Conditional

When “Yes” to “Was the merchandise delivered to the incorrect location?”

Was the merchandise delivered late?

Yes/No

Mandatory

Please provide details of late delivery.

Freeform Text

Conditional

When “Yes” to “Was the merchandise delivered late?”

Did you return the merchandise?

Yes/No

Conditional

Follows “Please provide details of late delivery.”

Did you attempt to return the merchandise?

Yes/No

Conditional

When “No” to “Was the merchandise delivered late?”

When did you attempt to return it?

Date

Conditional

When “Yes” to “Did you attempt to return the merchandise?”

When did you return the merchandise?

Date

Conditional

When “Yes” to “Was the merchandise delivered late?”

Do you know when the merchant received the merchandise?

Yes/No

Conditional

Follows “When did you return the merchandise?”

When did the merchant receive the merchandise?

Date

Conditional

When “Yes” to “Do you know when the merchant received the merchandise?”

What return method did you use?

Single Select

Face to Face

FedEx

DHL

UPS

Postal Service

Other

Conditional

Please Explain:

Freeform Text

Conditional

When “Other” to “What return method did you use?”

What was the tracking number?

Freeform Text

Conditional

When an option is selected besides “Other” to “What return method did you use?”

Did you cancel prior to the expected receipt date?

Yes/No

Mandatory

When did you cancel?

Date

Conditional

When “Yes” to “Did you cancel prior to the expected receipt date?”

Did you attempt to resolve with the merchant?

Yes/No

Mandatory

Are there local laws or regulations prohibiting you from resolving with the merchant?

Yes/No

Conditional

When “No” to “Did you attempt to resolve with the merchant?”

Please explain.

Freeform Text

Conditional

When “Yes” to “Are there local laws or regulations prohibiting you from resolving with the merchant?”

Do you have any additional information that should be provided to the merchant regarding your dispute?

Yes/No

Mandatory

Please provide any additional information. This will be provided to the merchant.

Freeform Text

Conditional

When “Yes” to “Do you have any additional information that should be provided to the merchant regarding your dispute?”

Do you have any additional information to provide about this dispute?

Yes/No

Mandatory

Please provide any additional information.

Freeform Text

Conditional

When “Yes” to “Do you have any additional information to provide about this dispute?”

Service

Question

Type

Values

Mandatory/Optional/Conditional

Notes

Did merchant cancel services?

Yes/No

Mandatory

Date the merchant cancelled services

Date

Conditional

When “Yes” to “Did merchant cancel services?”

Is the merchant in bankruptcy or liquidation?

Yes/No

Mandatory

Was non-fiat currency (e.g. cryptocurrency) or non-fungible token(s) not successfully delivered to the destination wallet address supplied by the Cardholder at the time of the Transaction?

Yes/No

Mandatory

Note: Please provide evidence that the non-fiat currency or non-fungible token(s) was not successfully delivered to the destination wallet address at the time of the Transaction.

Conditional

When “Yes” to “Was non-fiat currency (e.g. cryptocurrency) or non-fungible token(s) not successfully delivered to the destination wallet address supplied by the Cardholder at the time of the Transaction?”

Are you still expecting a service delivery?

Yes/No

Mandatory

What is the last expected receipt date for the service?

Date

Mandatory

Why are you initiating a dispute prior to the expected delivery date?

Freeform Text

Conditional

When “Yes” to “Are you still expecting a service delivery?”

What was the expected receipt time for the service?

Freeform Text

Mandatory

Did you cancel the service prior to the expected receipt date?

Yes/No

Mandatory

When did you cancel?

Date

Conditional

When “Yes” to “Did you cancel prior to the expected receipt date?”

Why did you cancel?

Freeform Text

Conditional

Follows “When did you cancel?”

Did you attempt to resolve with the merchant?

Yes/No

Mandatory

Are there local laws or regulations prohibiting you from resolving with the merchant?

Yes/No

Conditional

When “No” to “Did you attempt to resolve with the merchant?”

Please explain.

Freeform Text

Conditional

When “Yes” to “Are there local laws or regulations prohibiting you from resolving with the merchant?”

Do you have any additional information that should be provided to the merchant regarding your dispute?

Yes/No

Mandatory

Please provide any additional information. This will be provided to the merchant.

Freeform Text

Conditional

When “Yes” to “Do you have any additional information that should be provided to the merchant regarding your dispute?”

Do you have any additional information to provide about this dispute?

Yes/No

Mandatory

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