牡丹卡账务查询申明书.docVIP

附表1： 牡 丹 卡 账 务 查 询 申 明 书 Transaction Inquiry Form 卡号 (Acct No)： (Exp Date)： (Trans Date)： (Trans Location)： (Merchant Name)： (Trans Amount)： （，）(Multiple transactions--Please mark the transaction amount on the copy of the statement respectively) (Transaction Type)： □(Consumption) □取现(Cash Withdrawal) □转账(Account Transfer) □利息及费用(Interest Commission) 查询交易币种(Trans Currency)：□ (RMB) □外币(Foreign Currency) 查询内容 (Choice of Inquiry)： 1. □(Transaction Location )/商户名称(Merchant Name)： □ATM(ATM Transaction) □POS 交易(POS Transaction) □其他(Other) 2. □调阅单据，( Transaction Receipt Retrieval) □记账金额与实际消费金额不符 The amount billed is incorrect. The Transaction Amount should be ____ not _____. □ATM未吐钞已记账 ATM does not dispense □重复记账▁次 The charge listed was a single transaction but was posted ____ times to my account □实际消费未成功， Transaction was unsuccessful, but the amount have posted to my account □存款未达帐， Cash deposit did not post to my account, enclosed a copy of the deposit receipt □退货交易未到帐， Credit did not post to my account, I have enclosed a copy of the credit issued □无法回想起交易情况， I did not recognize the transaction, please provide the copy of the transaction receipt □非本人交易（，，）：Neither I, nor anyone else authorized by me engaged in this transaction. My credit card is in my possession, the account number was used fraudulently. The merchant continues to charge my account for periodic billings to my account that I canceled on _____. I was speaking with ______ (if know) and have attempted to resolve this dispute with the merchant. □本人尝试与商户联系要求退还所购货物，但遭到商户拒绝。I want to return the merchandise, I have contacted the merchant to resolved the dispute and the merchant refused to:_____ Adjust the price _____ Repair of replace the goods or other things of value _____ Issue a credit. □该笔消费本人已经以其他方式付过款，付款凭证附后，本人已经尝试与商户解决该争议。The charge listed was paid