Merchant Fraud Monitoring Request Form
Report a suspected fraudulent transaction or activity for prompt investigation.
Merchant Name
*
First Name
Last Name
Business Name
*
Contact Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Suspected Fraudulent Transaction
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Transaction Amount (in USD)
*
Transaction ID or Reference Number
The Last 4 Digits of the Card Used (if applicable)
Brief Description of the Suspected Fraudulent Activity
*
What actions have you taken so far?
Upload any supporting documentation (screenshots, correspondence, etc.)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Request
Should be Empty: