Procurement Cardholder Manual: GE Corporate Card Services

GE Corporate Card Services

Click the button above to download a printable version of this form . In the window that appears, you will be asked, "What do you want to do with this file?" Select "Open it." The form will open in MS word. Please print the form, fill it out and fax to 919-681-9062.

If you have a transaction appearing on your statement that you believe is in error, please complete and sign this form and return it to:

GE Corporate Card Services
PO Box 521300
Salt Lake City, UT 84152-1300

Or fax to: 1-(800)-471-9770. DO NOT mail this form with your payments. We must receive your dispute information in writing no later than 60 days from the date of the statement on which the error or problem occurred.

Credit Card Number:	Amount: $
Merchant/Vendor Name:
Reference Number: (from Credit Card statement)
Transaction Date:	Posting Date:

PLEASE SELECT ONE OF THE FOLLOWING:

	1.	I certify that the charge(s) listed above was/were not made or authorized by me, nor did I authorize anyone else to use my card.
	2.	Sales draft request (check one): Unfamiliar transaction _______ Need copy for records _______
	3.	I certify that the charge in question was a single transaction. I only authorized one charge and my card was in my possession at all times. The reference number of the charge I authorized is _________________________________.
	4.	I am expecting credit to my account because ____________________________ ___________________________. Please provide the merchant's written confirmation of credit.
	5.	I have not received the merchandise that was to have been shipped to me. Expected date of delivery was ____/____/____. I contacted the merchant on ____/____/____ and the merchant's response was _______________ __________________________________________.
	6.	I have returned merchandise on ____/____/____ because ____________________________________________. Please provide proof of your return (such as a UPS/FEDEX or USPS manifest or receipt) or the merchant's written confirmation of credit.
	7.	Merchandise which was shipped to me arrived damaged and/or defective on ____/____/____. I returned it on ____/____/____. Please provide proof of your return (such as a UPS/FEDEX or USPS manifest or receipt) or the merchant's written confirmation of credit.
	8.	I was charged an incorrect amount. The sales slip was increased from $ ____________ to $ ____________. Enclosed is a copy of my sales slip, which shows the correct amount.
	9.	I did not authorize a recurring charge of $ ___________ as services were canceled on ____/____/____. Method of cancellation was _______________________________________.
	10.	I cancelled this hotel reservation on ____/___/___. My cancellation number is_____________________________. Is ________________
	11.	Other: Please provide a detailed explanation of the dispute on a separate sheet of paper or on the reverse side of this form.

_____________________________________
Cardholder Signature

______________________
Date

______________________
Contact Number (work)

______________________
(fax)

______________________
(other)

Comments:_______________________________________________________________________________________ _______________________________________________________________________________________________