Retail Gift Card Fraud Report Form
Report suspected gift card fraud with incident details, gift card information, transaction data, supporting evidence, and follow-up notes.
Reporter Information
Full Name
*
First Name
Middle Name
Last Name
Job Title or Relationship to Case
*
Please Select
Store Associate
Manager
Loss Prevention
Security
Customer Service
Owner
Customer
Vendor
Other
Company or Store Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Incident Overview
Incident Date
*
 -
Month
 -
Day
Year
Date
Incident Time
Hour Minutes
AM
PM
AM/PM Option
Date and Time Discovered
*
 -
Month
 -
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Store Location or Branch
*
Report Type
*
Please Select
Suspected counterfeit card
Unauthorized redemption
Tampered card packaging
Suspicious transaction
Balance discrepancy
Other
Brief Summary of What Happened
*
Gift Card Details
Gift Card Brand or Program Name
*
Card Type or Format
*
Please Select
Physical Card
E-Gift Card
Reloadable Card
Store-Issued Card
Other
Last 4 Digits of Gift Card Number
Visible Card Identifier
Denomination or Value
Remaining Balance, if Known
Where the Card Was Obtained
Transaction and Fraud Details
Transaction date and time
*
 -
Month
 -
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Transaction or store reference number
Method of use or redemption
*
Please Select
In-store purchase
Online purchase
Phone order
In-app redemption
Gift card transfer
Other
Amount involved
*
Where was the card used?
*
In-store
Online
Both
Fraud indicators observed
Unauthorized redemption
Duplicate balance use
Suspicious customer behavior
Mismatched receipt
Altered packaging
Other
Suspected fraud pattern
*
Please Select
Account takeover
Card cloning
Resale fraud
Return fraud
Store employee misuse
Unknown
Other
How the fraud was detected
*
Impact and Evidence
Estimated Loss Amount
*
Balance Impact
*
Fully depleted
Partially affected
Unknown
Not applicable
Affected Account or Order Reference
Supporting Evidence
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Additional Notes and Immediate Actions Taken
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