Unauthorized Subscription Charge Dispute Form
Use this form to report and dispute unauthorized subscription charges on your account. Please provide as much detail as possible to help us investigate your claim.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Subscription Service or Merchant
*
Account Username or Subscription ID (if applicable)
Date of Unauthorized Charge
*
-
Month
-
Day
Year
Date
Amount Charged
*
The Last 4 Digits of Your Credit or Debit Card (if applicable)
Please describe the unauthorized charge and any actions you have taken so far
*
Preferred Resolution
*
Refund the unauthorized charge
Cancel the subscription
Investigate and contact me with next steps
Other
Upload any supporting documents (e.g., screenshots, emails, receipts)
Upload a File
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of
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