Unauthorized Refund Report Form
Report an unauthorized refund for investigation. Please provide detailed information to help us resolve your case efficiently.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone
Either
Date of Refund Transaction
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Refund Amount (USD)
*
Refund Method
*
Please Select
Debit/Credit Card
Bank Transfer
Cash
Digital Wallet/Payment App
Store Credit
Other
The Last 4 Digits of Your Card (if applicable)
Merchant or Store Name
*
Describe the Unauthorized Refund (include any relevant details)
*
Upload Supporting Documents (e.g., receipts, screenshots, statements)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Have you already contacted the merchant or financial institution about this refund?
*
Yes
No
Submit Report
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