Member Error Resolution Form

Member Error Resolution

Fields marked with * are required.

We must receive written notice from you no later than 60 days after we sent the first statement on which the problem or error appeared. You may call us, but doing so will not preserve your rights.

  1. Your name and member account number;
  2. The dollar amount of the suspected error and date;
  3. Describe the error or the transaction and explain as clearly as you can why you believe there is an error.
  4. For errors involving $15 or less, a receipt may not be required if no receipt was provided to you.

Please provide the following information:

Member Information
*
*
Member Account Number*
*
*
*
*
*
*
*
Dollar Amount of Suspected Error* $
*
Date of Suspected Error*
*
Please describe the error or the transaction and explain as clearly as you can why you believe there is an error.
*
A374-R03/11