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Online Dispute Form

Please note that you may still be required to visit a branch to complete the request process.

If your card has been lost or stolen, please contact our Customer Service Department at (256) 386-5000 or (877) 865-5050, visit one of our sales offices, or use the Manage Cards function in Online Banking or Mobile Banking to report your card lost or stolen. Thank you!

Card Holder Name *

Contact Phone # *

Last 4 Digits of Card # *

Have you been contacted by the Risk Management Fraud Center or by a Bank representative regarding the transaction(s)?

Yes

The following transactions are being disputed because my card is still in my possession and I have not authorized or participated in these transactions in any way:

Tran Date *

Tran Amount *

Merchant *

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Tran Amount

Merchant

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Merchant

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Merchant

Tran Date

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Merchant

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Merchant

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Tran Date

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Merchant

I certify that I am the cardholder named on the debit card identified above and that this information is true and correct to the best of my knowledge.

Thank you for your submission!

We will be in touch with you soon.