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?”

Amex Questionnaires

Related content