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Which of the following would you like to report?

I

...

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

I had an issue while using my card at an ATM.

There is an issue with the account.

...

participated in this transaction, but there is a problem.

View file
nameAmex Questionnaires.pdf

Orah tabs page
indexInGroup1
tabsPageTitleCharged More Than Once
primaryTabtrue
colorPalettesDefault
color#0052CC
idrez3x68wq2p

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

Values

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
indexInGroup2
tabsPageTitleMerchandise or Service Not Received
colorPalettesDefault
color#0052CC
idnrxg3jnvcm

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
indexInGroup3
tabsPageTitleCancelled or Returned Merchandise/Service
colorPalettesDefault
color#0052CC
idlbatkyonzne

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

Values

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
indexInGroup4
tabsPageTitleCancelled Recurring Transaction
colorPalettesDefault
color#0052CC
idy2dhdwsw58

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

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

Question

Type

Values

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
indexInGroup5
tabsPageTitleMerchandise or Service Issue
colorPalettesDefault
color#0052CC
id8ljbbsfiaim

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

Values

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

Values

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

Values

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
indexInGroup6
tabsPageTitleIncorrect Amount
colorPalettesDefault
color#0052CC
ida3xevcydapu

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

Values

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

Values

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?”