Cardholder Dispute Form | CA Fraud Claim

Fraudulent activity is a transaction confirmed to be unauthorized. By filing a fraud claim, you have confirmed:

The activity was not conducted by you or anyone you authorized to use your card or account.
This charge wasn’t made by another authorized user on your card or account.
You did not authorize anyone else use the member’s card or account.
You reviewed the transaction details and still do not recognize the transaction. Remember that merchants may use a different name or address for billing purposes.

If you have fraudulent activity on your credit card or debit card, please report it immediately by calling (650) 363-1725 before completing your claim so that Monterra can disable your credit card or debit card to prevent further fraudulent activity.

Your Information

Cardholder Name

Cardholder Name is a required field

Member, Account, or MICR Number

Member, Account, or MICR Number is a required field

Primary Contact Phone

Primary Contact Phone is a required field

Card Status Lost Stolen Never Received In my possession at all times when fraud occurred

Card Status is a required field

Member Discovery Date

Member Discovery Date is a required field

Card Number used in transaction

Card Number used in transaction is a required field

Phone Number Type

Phone Number Type is a required field

Has this loss been reported to the police department? Yes No

Has this loss been reported to the police department? is a required field

Please indicate card type Credit Card Debit Card

Please indicate card type is a required field

I have examined the charges made to my account and I am disputing the following charge(s) as neither I nor any person authorized by me to use my card, made the charge(s) listed below. In addition, neither I nor anyone authorized by me received goods and services represented by the transaction(s).

Transaction Information