Which of the following would you like to report?

I authorized a transaction, but it is incorrect.

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?”

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

My account was debited/credited before the date I authorized

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?”

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

My account was debited/credited for an amount different from what I authorized

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?”

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

My account was debited by a third party, but the third party failed to make the payment as instructed.

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?”

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

I was charged/credited more than once

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?”

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

A debit/credit to my account that was previously returned was improperly reinitiated.

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?”

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

My check was improperly processed electronically.

Question	Type	Values	Mandatory/Optional/Conditional	Notes
Which of the following best describe the reason the check was improperly processed:	Single Select	The original check was already presented for payment. The amount of the transaction was not accurately obtained from the check. I opted out of the check conversion activity. The Originator did not provide notice in accordance with the NACHA ACH Operating Rules. The original check was improper.	Mandatory
Please select the appropriate reason below:	Single Select	The signature on the original check is not authentic or authorized or the item has been altered. The check not eligible to be processed electronically. or the item has been altered. The check not eligible to be processed electronically	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?”

ACH Questionnaires