Debit Card Dispute Form
Debit Card Dispute
By submitting this application to the Credit Union, I/we promise that everything is correct. I declare under penalty of perjury that the forgoing is true and correct to the best of my ability. I state that I have carefully examined my checking and/or savings statement(s) and find that the above-described transaction(s) were not processed as requested by me, nor did I receive benefit or proceeds from the transactions. I swear this affidavit is true and understand that ALL VIDEO TAPES OF THE TRANSACTIONS WILL BE TURNED OVER TO POLICE, AND willful violations of the Federal Electronic Funds Transfer Act Regulation E carry criminal penalties, and conviction for fraudulent use of EFT services carries a $10,000.00 fine and a 10-year jail term. I declare under penalty of perjury that the forgoing is true and correct to the best of my ability.