Orco Bank Dispute Inquiry Credit Card

A dispute fee of USD$10 will be charged to your Credit Card account in order to initiate our investigation.

Please check/cross the appropriate box below and complete the information above, in detail. Signature is required. Return this form along with a copy of statement, a copy (signed) of sales receipt and a copy of credit slip to: Orco Bank Card Center, Schottegatweg Oost z/n, Landhuis Cerrito, Willemstad, Curaçao. Any negligence or non- compliance by the cardholder to dispute any fraudulent or unknown transaction within the stipulated timeframe will be the cardholder's responsibility.

I certify that the charge(s) listed above was (were) not made by either myself or a person authorized by me to use my credit card.

My payment did not post. (Please enclose a copy of the front and back of your cancelled check or money order).

The credit did not post to my account. (Please enclose a copy of your credit slip bearing the account number, merchant name, date, and dollar amount).

I was billed twice for a single purchase. (Describe the transaction in the space provided below).

I did not receive the merchandise or services. (Describe your attempts to resolve this matter with the merchant as well as the expected date of delivery in the space provided on the second page).

I was overcharged for the purchase. (Please enclose a copy of the signed sales receipt that includes your account number).

The merchant will not give credit. (Please enclose a copy of your sales slip and original store credit). Visa/MasterCard regulations prohibit the Service Center for assisting in this dispute if the sales slip reflects in- store credit or no refunds.

I would like a copy of a sales draft. (Describe transaction above and reason for your request in the space on the second page).

I was charged for a hotel room which I cancelled. (Please provide full details in the space provided below). You must provide your cancellation number in order for us to process your dispute, or the person’s name who accepted cancellation.

I was charged for a hotel that I neither made reservation for nor authorized reservation to be made for me.

My credit was posted as a sale. (Describe transaction “above” – on the first page and providing a copy of the credit card slip and the date of the original charge).

Merchant is defective. (Describe below the defect or damage, attempts to return the merchandise and merchant’s response). (Shipped merchandise only).

Merchandise has been returned. (Describe below what was expected and received, reason for return, merchant response and postal receipt or credit slip).

Service (Membership) cancelled). (Please enclose a copy of the letter that was provided to the merchant for cancellation and/or the date you called to cancel.

Service dispute. (Indicate below the nature of dispute and your attempts at resolution). Dispute must be more than USD$ 50, and made within your home state or within 100 miles of your current mailing address. These restrictions do not apply to mail or pho

Other. (Describe below). Description of transactions should be typed or printed clearly. Attach additional sheets if necessary.