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Is the issue you are reporting related to a transaction made with your card?

No

Which of the following would you like to report?

I have an issue with a bill payment.

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

I did not authorize this payment. I suspect fraud.

Question	Type	Mandatory/Optional/Conditional	Notes
Do you have Bill Pay set up with this merchant?	Yes/No	Mandatory
Were you contacted by anyone regarding a payment?	Yes/No	Mandatory
Did you perform the payment but later identified the payment was due to a scam?	Yes/No	Conditional	When “Yes” to “Were you contacted by anyone regarding a payment?”
Please describe the situation in which you were scammed.	Freeform Text	Conditional	When “Yes” to “Did you perform the payment but later identified the payment was due to a scam?”
Have you ever authorized anyone to use your online banking account?	Yes/No	Mandatory
Who did you give authorization to use your online banking?	Freeform Text	Conditional	When “Yes” to “Have you ever authorized anyone to use your online banking account?”
Have you ever shared your online banking credentials?	Yes/No	Mandatory
Who did you share your online banking credentials with?	Freeform Text	Conditional	When “Yes” to “Have you ever shared your online banking credentials?”
Please describe in detail the reason for your dispute.	Freeform Text	Mandatory
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?”

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

I made this payment, but there is a problem and I need to dispute it

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

The payment was processed on the wrong date or for the wrong amount.

Question	Type	Mandatory/Optional/Conditional	Notes
What date should the payment have been sent?	Date	Mandatory
What was the expected payment amount?	Freeform Text	Mandatory
Was the payment sent late?	Yes/No	Mandatory
Is this dispute in regards to a fee charged by the payee?	Yes/No	Conditional	When “Yes” to “Was the payment sent late?”
What was the amount of the fee?	Freeform Text	Conditional	When “Yes” to “Is this dispute in regards to a fee charged by the payee?”
Do you have proof or documentation of the fee?	Yes/No	Conditional	Follows “What was the amount of the fee?”
Please describe in detail the reason for your dispute.	Freeform Text	Mandatory
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?”

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

The payee did not receive the funds.

Question	Type	Mandatory/Optional/Conditional	Notes
Who was the intended recipient of the payment?	Freeform Text	Mandatory
What account number should the payment have been sent to?	Freeform Text	Mandatory
What address should the check have been sent to?	Freeform Text	Mandatory
Did you contact the payee?	Yes/No	Mandatory
Please describe in detail the reason for your dispute.	Freeform Text	Mandatory
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?”

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