牡丹卡账务查询申明书.docVIP

牡丹卡账务查询申明书 牡丹卡账务查询申明书 PAGE / NUMPAGES 牡丹卡账务查询申明书 附表 1： 牡丹卡账务查问声明书 牡丹卡账务查问申 书 Transaction Inquiry Form 卡号 (Acct No) ： 卡片有效期 (Exp Date) ： 交易日期 (Trans Date) ： 交易国家或地域 (Trans Location) ： 中国 商户名称 (Merchant Name) ： 交 易 总数 (Trans Amount) ： （ 如 为多 笔交 易 ，请 提 供 对账 单 复 印 件 勾明 详细 交易 ） (Multiple transactions--Please mark the transaction amount on the copy of the statement respectively) 查问种类 (Transaction Type) ： □花费 (Consumption) □ 取现 (Cash Withdrawal) □转账 (Account Transfer) □ 利息及花费 (Interest Commission) 查问交易币种 (Trans Currency) ：□人民币 (RMB) □外币 (Foreign Currency) 查问内容 (Choice of Inquiry) ： 1.□查问交易场所 (Transaction Location )/ 商户名 2. 称(Merchant Name) ： □ ATM交易(ATM Transaction) □POS 交易 (POS Transaction) □其余 (Other) □调阅票据，原由以下 ( Transaction Receipt Retrieval) □记账金额与实质花费金额不符 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 □实质花费未成功，账户已被扣帐 Transaction was unsuccessful, but the amount have posted to my account □存款未达帐，存款单附后 Cash deposit did not post to my account, enclosed a copy of the deposit receipt □退货交易未到帐，退货票据附后 Credit did not post to my account, I have enclosed a copy of the credit issued □没法回忆起交易状况，请调取交易票据供自己检验 I did not recognize the transaction, please provide the copy of the transaction receipt □非自己交易（指交易非自己所为，亦未受权别人使用，卡在自己手中） ： 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. □按期付费交易已于 _____日撤消，但商户仍持续按期向自己账户中收费， 自己已经试试过与商户解决该问题。 The merchant continues to charge my account for periodicbillings to my account that I canceled on _____. I was speaking with ______ (if know) and have attempted to resolve this dispute with the merchant. □自己试试与商户联系要求退还所购货物，但受到商户拒绝。 I want to return the merchandise, I have contacted the merchant to resolved the dispute and the merchant refused to:_____ Adjust the pri