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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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