Should the cardholder be unable to reach agreement with the supplier, the cardholder should complete and submit a Statement of Questioned Item form with supporting documentation to his/her account manager. This form should be submitted within 15 days of the purchase. The account manager will then forward a copy of the form to their Campus Card Administrator and the original to the bank. The bank will institute an investigation. Forms are available in from the Campus Card Administrator.
During the bank's investigation, a credit will be issued to the cardholder’s default account for the questioned amount. The default account is the fund-area-org or purchase order number associated to a particular Purchasing Card.
After the investigation is complete, the cardholder will be notified of the resolution. The cardholder should then notify the account manager of the results of the bank's investigation.
Should the dispute not be settled in favor of the cardholder, the cardholder’s default account will be charged for the disputed transaction amount.
Account manager's should document disputed transactions just like any other charge to the cardholder's account. Supporting documentation, includes copies of the Statement of Questioned Item form, any notes regarding the conversation(s) that have taken place between the supplier and the cardholder and/or account manager, and any resolution information sent from the bank. Refer to Procedure 9-110 Documentation and Record Retention, for further details.
 |
Cardholder Name and Return Address |
Enter your campus address where you can be reached during the day for
any necessary inquiries or where you would like a notice sent once the issue has
been researched and resolved. This may be the address of a department support
person, if you are not generally available to answer these questions. |
 |
Account No. |
Enter your account number from your purchasing card. |
 |
Merchant Name |
Enter the name of the merchant with whom you have the disputed charge.
This should be on your invoice or receipt, or on the detail transaction
in Banner. |
 |
Transaction Date |
Enter the date the transaction occurred. This would be the date on
the invoice or receipt, or the transaction date from the HUM table. |
 |
Posting Date |
Enter the date the transaction was processed by the bank. This is the posting date displayed on the Banner FAAINVT form. If you do not have access to this date - contact your account manager for assistance. |
 |
Reference # |
Enter the bank's reference number for this transaction. The number is available on the Banner FAAINVT form or on your monthly statement. If you do not have access to this number - contact your account manager for assistance. |
 |
Amount |
Enter the amount of the disputed transaction in total. If you are disputing
only part of the amount, indicate that in the appropriate location below. |
|
Read the following options, and circle the number
beside the one that most closely meets your particular circumstances.
|
 |
You did not make the charge |
Circle the number 1. on the left side of the page. This indicates that you do not recognize the charge, do not believe the charge is yours and have contacted the merchant to attempt to get more information. |
 |
You have been billed more than once for the same charge. |
Circle the number 2. on the left side of the page. |
|
|
Enter the Amount, Bank Reference # and Transaction Date of the transaction you did authorize
This data is available on the Banner Form FAAINVT or on your monthly statement. If you do not have access to this information, contact your account manager |
|
|
Enter the Amount, Bank Reference # and Transaction Date of the transaction you did NOT authorize
This data is available on the Banner Form FAAINVT or on your monthly statement. If you do not have access to this information, contact your account manager |
|
You have already cancelled the charge but the credit has not been applied |
Circle the number 3. on the left side of the page. |
|
|
Enter the Date the charge was cancelled and the cancellation number you recieved when you cancelled the charge. |
 |
You have been charged for something you ordered but have not
yet received |
Circle the number 4. on the left side of the page. |
|
|
Enter the Date the goods were shipped by the merchant. |
 |
The goods were shipped but arrived damaged and you have returned them. The credit does not yet appear on your bill. |
Circle the number 5. on the left side of the page. |
|
|
Enter the Date the goods were returned to the merchant.
Attach a copy of the mail or shipping receipt. |
 |
You returned the goods to the merchant's store but have not yet received a credit. |
Circle the number 6. on the left side of the page.
Attach a copy of your credit receipt from the merchant. |
 |
The purchase was not made with this card, it was paid for by some other means. |
Circle the number 7. on the left side of the page.
Attach a copy of documentation that demonstrates the alternative payment method. |
 |
The amount charged is incorrect |
Circle the number 8. on the left side of the page. |
|
|
Enter the Amount from your receipt and the Amount you were charged.
Attach a copy of the receipt displaying the correct amount. |
 |
You have been charged for something you did not order or authorize. |
Circle the number 9. on the left side of the page.
The comment in red can be ignored - USNH cards are MasterCard |
 |
Some other reason for the dispute that one of the above does not cover. |
Circle the number 10. on the left side of the page.
Attach a detailed description of the dispute. Attach receipts or other materials that help to support your dispute. |
 |
Work Phone |
Enter a number where you can be reached for questions regarding this dispute. This may also be your account manager's, if that person is managing the dispute for you. |
 |
Email Address |
Enter an email address where you can be reached. This may also be your account manager's, if that person is managing the dispute for you. |
 |
Fax Number |
Enter a Fax number that is available to you. This may also be your account manager's, if that person is managing the dispute for you. |
 |
Signature |
This must be signed by the authorized cardholder. |
 |
Date |
Today's date. |
|
When Complete, please mail to:
Chase Card Services, Attn: Commercial Card dispute Dept.
PO Box 182918
Columbus, OH 43272-5543
Or Fax to: 866-865-2298
Or Email the document as an attachment to: CCSColumbusDisputes@chase.com |
