If the transaction was already reported to Visa Fraud what was the date it was reported? _____________ I am disputing the above charges due to the following reason (check only one reason): _____ I have not, nor has anyone authorized by me engaged in this transaction.
My card was stolen on (date): __________
_____ I have not authorized or participated in this transaction in any way. My card has not been out of my possession.
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Please provide specific details below or on a separate sheet of paper if needed. __________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
*** I give my consent to the credit union to release any information regarding my card and/or card account to any local,
state and/or federal law enforcement agency so that the information can, if necessary, be used in the investigation and/or prosecution of any person(s) who may be responsible for fraud involving my card and or card account. I swear this affidavit is true and understand that making a false sworn statement is subject to federal and/or state statues and maybe punishable by fines and/or by imprisonment.
Signature: _____________________________________________________ Date: _______________________________ Phone Number: _________________________________ Daytime Alternate Number: ____________________________ ***Employee initials: _____________________
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * We cannot stop or prevent a charge/authorized purchase from posting to an account; however, you may dispute the charge/purchase once it is posted. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Written notification must be received within 60 days upon receipt of the first statement on which the charge(s) appeared. * Charges more than 120 days old are past the allowed charge back timeframe and are not normally allowable. If in doubt, contact our Visa Department for clarification prior to completing this form. * If requesting a copy of a charge receipt, we must allow the merchant up to 30 days to fulfill your request (45 days on international purchases). * You must allow 30 days for receipt of shipped merchandise unless the merchant stipulated a specific delivery date when the order was placed. * If you returned the merchandise to the merchant, you must allow the merchant 30 days, from the return date, to issue credit to your account. * In order to protect your dispute rights provided by Visa®, the purchase must have been processed through the Visa® Network. Discrepancies with ATM/PIN transactions follow separate guidelines. For internal use only: What was the date the card was listed on the exception file? ________________
If you have any questions, please call (989) 835-7794 or (800) 835-7794.
Please fax completed form to (989) 832-9295 or return to DCECU, P.O. Box 1649, Midland, MI 48641-1649.
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Title: Five Years of Letrozole Compared with Tamoxifen as Initial Adjuvant Therapy for Postmenopausal Women with Endocrine-Responsive Early Breast Cancer: Update of Study BIG 1-98 Study Design BIG 1.98 is a four arm trial evaluating aromatase inhibitors for post-menopausal hormone receptor positive breast cancer. Subjects 8,028) were randomized to receive either: ARM A: tamoxifen al
Economic Evaluation of Treatment Strategies for Benign Prostatic Hyperplasia—Is Medical Therapy More Costly in the Long Run? Christopher S. Saigal,* Mehran Movassaghi, Jennifer Pace, Geoffrey Joyce and the Urologic Diseases in America Project From the Department of Urology, University of California-Los Angeles Medical Center, Los Angeles, California Purpose: Although medical therapy fo