RCPA Fleet Card — Dispute Processing Form

Important: Selecting one or more of the fraud-related reasons below (lost/stolen, certification, or “other” under fraud) indicates fraud, and the card(s) in question will be permanently blocked.

Fraud-related reasons

The card in question was lost/stolen Neither I, nor anyone associated with my company, used the card for the transaction(s) listed on this dispute form or listed on the attached spreadsheet/billing statement (if applicable). Transactions must be clearly notated which are disputed. Other (fraud-related)

Other claim reasons

Requested card was never received The amount of the transaction is different from the amount billed I participated in at least one transaction with this merchant, but did not participate in the disputed transaction(s) Credit not processed The cardholder was debited more than once for the same goods and services The cardholder was billed twice for the same transaction

Please include supporting documentation (e.g., MasterCard Purchases Billing Detail report) in the Documents step.

The transaction was billed for a higher amount than the receipt shows

Please include a copy of the receipt in the Documents step.

Dispute Processing Form

Claim submitted

Account & contact

Dispute reasons

Fraud-related reasons

Other claim reasons

Identify transactions

Bulk paste transactions

Supporting documents & comments

Review & submit

Transaction