Credit Card Fee Assessment Form
Please provide details about your recent credit card fee experience. Do not enter any sensitive card or personal information.
The Last 4 Digits of Your Credit Card
*
Transaction or Account Reference Number
*
Date of Fee Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Fee Assessed
*
Please Select
Annual Fee
Late Payment Fee
Foreign Transaction Fee
Balance Transfer Fee
Cash Advance Fee
Other
Amount of Fee (USD)
*
How clear was the explanation of this fee on your statement?
*
Not clear at all
1
2
3
4
Very clear
5
1 is Not clear at all, 5 is Very clear
How fair do you feel this fee was?
*
Very unfair
1
2
3
4
Very fair
5
1 is Very unfair, 5 is Very fair
Overall satisfaction with the fee assessment process
*
1
2
3
4
5
Fee Details Breakdown
Rows
Amount (USD)
Date Charged
Description
Fee 1
Fee 2
Fee 3
Additional Comments or Feedback
Submit Assessment
Should be Empty: