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name	Amex Questionnaires.pdf

Orah tabs page

indexInGroup	1
tabsPageTitle	Charged More Than Once
primaryTab	true
colorPalettes	Default
color	#0052CC
id	rez3x68wq2p

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

I was charged more than once.

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Is the valid transaction on this same account?	Yes/No		Mandatory
Please select a valid transaction.	Transaction Select		Conditional	When “Yes” to “Is the valid transaction on this same account?”
Is the other transaction on a [Name] card?	Yes/No		Conditional	When “No” to “Is the valid transaction on this same account?”
Select the account the charge(s) appear on:	Account Select		Conditional	When “Yes” to “Is the other transaction on a [Name] card?”
Please select a valid transaction.	Transaction Select		Conditional	Follows “Select the account the charge(s) appear on:”
What was the other form of payment?	Single Select	Another Card Check Cash Other	Conditional	When “No” to “Is the other transaction on a [Name] card?”
Please explain.	Freeform Text		Conditional	When “Other” is selected under “What was the other form of payment?”
Is the dispute regarding airline tickets?	Yes/No		Mandatory
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

Airline Tickets

Question	Type	Mandatory/Optional/Conditional	Notes
Is the dispute regarding airline tickets?	Yes/No	Mandatory
Does this dispute involve voided airline tickets, where you are waiting for a credit?	Yes/No	Conditional	When “Yes” to “Is the dispute regarding airline tickets?”
Please explain:	Freeform Text	Conditional	When “Yes” to “Does this dispute involve voided airline tickets, where you are waiting for a credit?”
Do you have airline ticket numbers for each charged transaction?	Yes/No	Conditional	When “No” to “Does this dispute involve voided airline tickets, where you are waiting for a credit?”
Please enter the ticket numbers.	Freeform Text	Conditional	When “Yes” to “Do you have airline ticket numbers for each charged transaction?”
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

Orah tabs page

indexInGroup	2
tabsPageTitle	Merchandise or Service Not Received
colorPalettes	Default
color	#0052CC
id	nrxg3jnvcm

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

I haven't received merchandise or a service I purchased.

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Are you disputing the total remaining amount of the transaction? [Amount]	Yes/No		Mandatory
What amount are you disputing?	Freeform Text	Numerical Only	Conditional	When “No” to “Are you disputing the total remaining amount of the transaction? [Amount]”
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
Is the expected receipt date for the merchandise or services known?	Yes/No		Mandatory
When was the merchandise/services expected to be received?	Date	Merchandise Service	Conditional	When “Yes” to “Is the expected receipt date for the merchandise or services known?”
Has it been confirmed that the merchant will not provide the merchandise/services? (ie. Merchant is no longer in business)	Yes/No		Mandatory
Please explain.	Freeform Text		Conditional	When “Yes” to “Has it been confirmed that the merchant will not provide the merchandise/services? (ie. Merchant is no longer in business)”
What date did you learn the merchandise/services would not be received?	Date		Conditional	When “Yes” to “Has it been confirmed that the merchant will not provide the merchandise/services? (ie. Merchant is no longer in business)”
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

Orah tabs page

indexInGroup	3
tabsPageTitle	Cancelled or Returned Merchandise/Service
colorPalettes	Default
color	#0052CC
id	lbatkyonzne

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

I cancelled or returned the merchandise or service and have not received the expected credit.

Question

Type

Values

Mandatory/Optional/Conditional

Notes

Are you disputing the total remaining amount of the transaction? [Amount]

Yes/No

Mandatory

What amount are you disputing?

Freeform Text

Numerical Only

Conditional

When “No” to “Are you disputing the total remaining amount of the transaction? [Amount]”

What was purchased?

Single Select

Merchandise

Service

Merchandise

Question	Type	Mandatory/Optional/Conditional	Notes
Please provide a description of what was ordered.	Freeform Text	Mandatory
When did you receive or expect to receive the merchandise?	Date	Mandatory
Did you cancel?	Yes/No	Mandatory
When did you cancel?	Date	Conditional	When “Yes” to “Did you cancel?”
How did you cancel?	Freeform Text	Conditional	When “Yes” to “Did you cancel?”
Was a cancellation number provided?	Yes/No	Conditional	When “Yes” to “Did you cancel?”
What is the cancellation number?	Freeform Text	Conditional	When “Yes” to “Was a cancellation number provided?”
Was a cancellation policy provided?	Yes/No	Conditional	When “Yes” to “Did you cancel?”
What was the policy?	Freeform Text	Conditional	When “Yes” to “Was a cancellation policy provided?”
Was the merchandise received?	Yes/No	Mandatory
Was the merchandise refused upon delivery?	Yes/No	Mandatory
What date was the merchandise refused on?	Date	Conditional	When “Yes” to “Was the merchandise refused upon delivery?”
Please explain.	Freeform Text	Conditional	When “Yes” to “Was the merchandise refused upon delivery?”
Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?	Yes/No	Mandatory
What is the date on the credit voucher, transaction receipt, or refund acknowledgement?	Date	Conditional	When “Yes” to “Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?”
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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
Please provide a description of the service.	Freeform Text		Mandatory
When was the service provided or expected?	Date		Mandatory
Did you cancel?	Yes/No		Mandatory
When did you cancel?	Date		Conditional	When “Yes” to “Did you cancel?”
How did you cancel?	Freeform Text		Conditional	When “Yes” to “Did you cancel?”
Was a cancellation number provided?	Yes/No		Conditional	When “Yes” to “Did you cancel?”
What is the cancellation number?	Freeform Text		Conditional	When “Yes” to “Was a cancellation number provided?”
Was a cancellation policy provided?	Yes/No		Conditional	When “Yes” to “Did you cancel?”
What was the policy?	Freeform Text		Conditional	When “Yes” to “Was a cancellation policy provided?”
Was the merchandise received?	Yes/No		Mandatory
Was the service refused?	Yes/No		Mandatory
What date was the service refused on?	Date		Conditional	When “Yes” to “Was the merchandise refused upon delivery?”
Please explain.	Freeform Text		Conditional	When “Yes” to “Was the merchandise refused upon delivery?”
Is the dispute regarding a “No-Show” charge?	Yes/No		Mandatory
Were the accommodations used?	Yes/No		Conditional	When “Yes” to “Is the dispute regarding a ‘No-Show’ charge?”
Did the merchant provide alternate accommodations and still charge for a “no-show”?	Yes/No		Conditional	When “Yes” to “Is the dispute regarding a ‘No-Show’ charge?”
Was the “no-show” charge different from the quoted rate?	Yes/No		Conditional	When “Yes” to “Is the dispute regarding a ‘No-Show’ charge?”
What was the quoted rate?	Freeform Text	Numerical Only	Conditional	When “Yes” to “Was the ‘no-show’ charge different from the quoted rate?”
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

Orah tabs page

indexInGroup	4
tabsPageTitle	Cancelled Recurring Transaction
colorPalettes	Default
color	#0052CC
id	y2dhdwsw58

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

I have an issue with a recurring transaction on my account.

Question	Type	Mandatory/Optional/Conditional	Notes
When did you cancel?	Date	Mandatory
How did you cancel?	Freeform Text	Mandatory
Was a cancellation policy provided?	Yes/No	Mandatory
What was the policy?	Freeform Text	Conditional	When “Yes” to “Was a cancellation policy provided?”
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

Orah tabs page

indexInGroup	5
tabsPageTitle	Merchandise or Service Issue
colorPalettes	Default
color	#0052CC
id	8ljbbsfiaim

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

I am dissatisfied with the merchandise or a service I received.

What is the issue with the merchandise or service?

The merchandise is damaged or defective.

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Are you disputing the total remaining amount of the transaction? [Amount]	Yes/No		Mandatory
What amount are you disputing?	Freeform Text	Numerical Only	Conditional	When “No” to “Are you disputing the total remaining amount of the transaction? [Amount]”
Please provide a description of what you purchased and how it is damaged or defective.	Freeform Text		Mandatory
When did you receive the merchandise?	Date		Mandatory
Did you return the merchandise?	Yes/No		Mandatory
When did you return the merchandise?	Date		Conditional	When “Yes” to “Did you return the merchandise?”
What address was the merchandise returned?	Freeform Text		Conditional	When “Yes” to “Did you return the merchandise?”
What return method did you use?	Single Select	Face to Face FedEx DHL UPS Postal Service Other
Do you have a tracking number?	Yes/No		Conditional	When “FedEx,” “DHL,” “UPS,” “Postal Service” is selected under “What return method did you use?”
What was the tracking number?	Freeform Text		Conditional	When “Yes” to “Do you have a tracking number?”
Please Explain:	Freeform Text		Conditional	When “Other” is selected under “What return method did you use?”
Can you provide proof the merchandise was returned?	Yes/No		Conditional	When “Yes” to “Did you return the merchandise?”
Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?	Yes/No		Mandatory
What is the date on the credit voucher, transaction receipt, or refund acknowledgement?	Date		Conditional	When “Yes” to “Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?”
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

What is the issue with the merchandise or service?

The merchandise or service has a quality issue.

Question

Type

Values

Mandatory/Optional/Conditional

Notes

Are you disputing the total remaining amount of the transaction? [Amount]

Yes/No

Mandatory

What amount are you disputing?

Freeform Text

Numerical Only

Conditional

When “No” to “Are you disputing the total remaining amount of the transaction? [Amount]”

What was purchased?

Single Select

Merchandise

Service

Mandatory

Merchandise

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Please provide a description of the merchandise and the quality issue.	Freeform Text		Mandatory
When did you receive the merchandise/service?	Date		Mandatory
Did you return the merchandise?	Yes/No		Mandatory
When did you return the merchandise?	Date		Conditional	When “Yes” to “Did you return the merchandise?”
What address was the merchandise returned?	Freeform Text		Conditional	When “Yes” to “Did you return the merchandise?”
What return method did you use?	Single Select	Face to Face FedEx DHL UPS Postal Service Other
Do you have a tracking number?	Yes/No		Conditional	When “FedEx,” “DHL,” “UPS,” “Postal Service” is selected under “What return method did you use?”
What was the tracking number?	Freeform Text		Conditional	When “Yes” to “Do you have a tracking number?”
Please Explain:	Freeform Text		Conditional	When “Other” is selected under “What return method did you use?”
Can you provide proof the merchandise was returned?	Yes/No		Conditional	When “Yes” to “Did you return the merchandise?”
Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?	Yes/No		Mandatory
What is the date on the credit voucher, transaction receipt, or refund acknowledgement?	Date		Conditional	When “Yes” to “Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?”
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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	Mandatory/Optional/Conditional	Notes
Please provide a description of the service and the quality issue.	Freeform Text	Mandatory
When did you receive the service?	Date	Mandatory
Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?	Yes/No	Mandatory
What is the date on the credit voucher, transaction receipt, or refund acknowledgement?	Date	Conditional	When “Yes” to “Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?”
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

What is the issue with the merchandise or service?

The merchandise or service is not as described.

Question

Type

Values

Mandatory/Optional/Conditional

Notes

Are you disputing the total remaining amount of the transaction? [Amount]

Yes/No

Mandatory

What amount are you disputing?

Freeform Text

Numerical Only

Conditional

When “No” to “Are you disputing the total remaining amount of the transaction? [Amount]”

What was purchased?

Single Select

Merchandise

Service

Mandatory

Merchandise

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Please provide details of what was ordered and not as described.	Freeform Text		Mandatory
When did you receive the merchandise/service?	Date		Mandatory
Did you return the merchandise?	Yes/No		Mandatory
When did you return the merchandise?	Date		Conditional	When “Yes” to “Did you return the merchandise?”
What address was the merchandise returned?	Freeform Text		Conditional	When “Yes” to “Did you return the merchandise?”
What return method did you use?	Single Select	Face to Face FedEx DHL UPS Postal Service Other
Do you have a tracking number?	Yes/No		Conditional	When “FedEx,” “DHL,” “UPS,” “Postal Service” is selected under “What return method did you use?”
What was the tracking number?	Freeform Text		Conditional	When “Yes” to “Do you have a tracking number?”
Please Explain:	Freeform Text		Conditional	When “Other” is selected under “What return method did you use?”
Can you provide proof the merchandise was returned?	Yes/No		Conditional	When “Yes” to “Did you return the merchandise?”
Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?	Yes/No		Mandatory
What is the date on the credit voucher, transaction receipt, or refund acknowledgement?	Date		Conditional	When “Yes” to “Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?”
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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	Mandatory/Optional/Conditional	Notes
Please provide details of what was ordered and not as described.	Freeform Text	Mandatory
When did you receive the service?	Date	Mandatory
Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?	Yes/No	Mandatory
What is the date on the credit voucher, transaction receipt, or refund acknowledgement?	Date	Conditional	When “Yes” to “Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?”
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

What is the issue with the merchandise or service?

The merchant violated local laws or regulations.

Question	Type	Mandatory/Optional/Conditional	Notes
Are you disputing this charge because a law or regulation was not followed by the merchant?	Yes/No	Mandatory
Please describe.	Freeform Text	Conditional	When “Yes” to “Are you disputing this charge because a law or regulation was not followed by the merchant?”
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

Orah tabs page

indexInGroup	6
tabsPageTitle	Incorrect Amount
colorPalettes	Default
color	#0052CC
id	a3xevcydapu

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

I was charged the wrong amount or the charge posted incorrectly.

How were you charged or credited incorrectly?

I was charged the wrong amount

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Are you disputing the full amount of the transaction?	Yes/No		Mandatory
To dispute a transaction for an incorrect amount, the amount disputed must be less than the full transaction amount. Please go back and choose a new claim reason.			Conditional	When “Yes” to “Are you disputing the full amount of the transaction?”
What is the correct amount that should have been charged?	Freeform Text	Numerical Only	Mandatory
Was the correct amount on your receipt?	Yes/No		Mandatory
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

How were you charged or credited incorrectly?

The transaction was presented late

Question	Type	Mandatory/Optional/Conditional	Notes
Is the account the transaction authorized on closed?	Yes/No	Mandatory
When was the transaction authorized?	Date	Mandatory
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

How were you charged or credited incorrectly?

I was charged incorrectly as a result of a currency conversion

Question	Type	Mandatory/Optional/Conditional	Notes
Please explain the currency discrepancy that occurred.	Freeform Text	Mandatory
Did you attempt to resolve with the merchant?	Yes/No	Mandatory
Please explain:	Freeform Text	Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

How were you charged or credited incorrectly?

I was charged for a no show reservation or advance deposit transaction incorrectly

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Were the accommodations used?	Yes/No		Mandatory
Did the merchant provide alternate accommodations and still charge for a “no-show”?	Yes/No		Mandatory
Was the “no-show” charge different from the quoted rate?	Yes/No		Mandatory
What was the quoted rate?	Freeform Text	Numerical Only	Conditional	When “Yes” to “Was the ‘no-show’ charge different from the quoted rate?”
Did you cancel?	Yes/No		Mandatory
When did you cancel?	Date		Conditional	When “Yes” to “Did you cancel?”
How did you cancel?	Freeform Text		Conditional	When “Yes” to “Did you cancel?”
Was a cancellation number provided?	Yes/No		Conditional	When “Yes” to “Did you cancel?”
What is the cancellation number?	Freeform Text	Numerical Only	Conditional	When “Yes” to “Was a cancellation number provided?”
Was a cancellation policy provided?	Yes/No		Conditional	When “Yes” to “Did you cancel?”
What was the policy?	Freeform Text		Conditional	When “Yes” to “Was a cancellation policy provided?”
Was the service refused?	Yes/No		Mandatory
What date was the service refused on?	Date		Conditional	When “Yes” to “Was the service refused?”
Please explain.	Freeform Text		Conditional	When “Yes” to “Was the service refused?”
Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?	Yes/No		Mandatory
What is the date on the credit voucher, transaction receipt, or refund acknowledgement?	Date		Conditional	When “Yes” to “Were you provided a credit voucher, voided transaction receipt or refund acknowledgement?”
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

How were you charged or credited incorrectly?

I was charged for loss, theft, or damages in addition to the service

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Are you disputing the total remaining amount of the transaction? [Amount]	Yes/No		Mandatory
What amount are you disputing?	Freeform Text	Numerical Only	Conditional	When “Yes” to “Are you disputing the total remaining amount of the transaction? [Amount]”
Did you purchase collision, loss, or theft insurance from the rental agency?	Yes/No		Mandatory
Please explain what is covered by the insurance.	Freeform Text		Conditional	When “Yes” to “Did you purchase collision, loss, or theft insurance from the rental agency?”
Is the dispute regarding additional charges related to theft or loss of a rental?	Yes/No		Mandatory
Please explain where the rental was stolen/lost.	Freeform Text		Conditional	When “Yes” to “Is the dispute regarding additional charges related to theft or loss of a rental?”
Is the dispute regarding additional charges related to damages?	Yes/No		Mandatory
Please explain what the additional charges.	Freeform Text		Conditional	When “Yes” to “Is the dispute regarding additional charges related to damages?”
Are the damages covered by the rental insurance?	Yes/No		Conditional	When “Yes” to “Is the dispute regarding additional charges related to damages?”
Please reply to our communication and send a copy of the rental agreement and any other supporting documentation that can be provided.			Conditional	When “Yes” to “Are the damages covered by the rental insurance?”
Did you receive an estimate for the damages?	Yes/No		Conditional	When “No” to “Are the damages covered by the rental insurance?”
What was the estimate for the damages?	Freeform Text	Numerical Only	Conditional	When “Yes” to “Did you receive an estimate for the damages?”
Was the rental determined to be a total loss?	Yes/No		Conditional	When “No” to “Did you receive an estimate for the damages?”
Did you agree to pay for the damages?	Yes/No		Conditional	When “No” to “Was the rental determined to be a total loss?”
Did you attempt to resolve with the merchant?	Yes/No		Mandatory
Please explain:	Freeform Text		Conditional	When “Yes” to “Did you attempt to resolve with the merchant?”
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?”

How were you charged or credited incorrectly?

The issuer identified the transaction was presented on the wrong account

Question	Type	Values	Mandatory/Optional/Conditional	Notes
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?”

How were you charged or credited incorrectly?

The issuer received a transaction on a unassigned account number

Question	Type	Values	Mandatory/Optional/Conditional	Notes
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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