Written Statement

Improper POS or ATM Activity

Follow the guidelines below, and resolve your claim quickly.

Send your completed forms with documentation today.

4 Easy Steps!

□ CONTACT THE MERCHANT

If you authorized a transaction yet disagree with the amount or other aspects
of it, we suggest that you first contact the merchant to resolve it. If your attempt
to resolve it with the merchant fails, you may initiate a claim with us.

□ Details and Facts:

We want to help you! If your attempt to resolve the problem with the merchant was
unsuccessful, the next step is to complete the Written Statement form. Please
provide specific details and the supporting documents.

□ PROVIDE PROOF
We want you to win your case! Send the supporting documentation to prove
your claim. Your supporting documentation helps us win the case with the merchant
in your behalf, quickly and efficiently.

□ SIGN AND SEND

Sign and date the written statement. Send the documents to us by mail or via the
upload option in FAQ.
1. Return by US Mail: BankMobile Card Services - ATTN: Dispute Dept, PO Box
543000 Omaha, NE 68154 or upload file via FAQ
2. FAQ: Log into your account; click the FAQ link and follow the directions to locate
and attach the file to the support ticket.

Return by US Mail: BankMobile Card Services - ATTN: Dispute Dept, PO Box 543000 Omaha, NE 68154 Page 1 of 4
or upload file via FAQ
 Written Statement

Improper POS or ATM Activity

Question: Is this transaction an Improper POS or an ATM?

Answer: Please read the information provided below. If you still are unsure, contact the Customer Care number located on the back of
your card. We will be happy to explain further.

Question: What is a POS transaction?

Answer: POS is an acronym for “Point of Sale. A Point of Sale transaction is one performed at a location where credit/debit card
transactions occur with the cardholder present, such as a retail store. The card is read magnetically and the cardholder's signature may
be obtained as insurance, or proof of authorization for the transaction.

Question: What is an ATM transaction?

Answer: ATM is an acronym for Automated Teller Machine. An ATM transaction is performed through an automated teller machine
(ATM) or money dispenser using your debit card and your secure personal identification number (PIN).

Question: What types of POS transactions would be considered improper?

Answer: Improper POS transactions are transactions authorized by you and considered improper because an error occurred. Some
of the most common reasons for a POS transaction to be deemed improper are listed below:

1. The merchant debited your account for an incorrect amount.

2. The merchant debited your account on a date other than the one you authorized.
3. The merchant debited your account too many times.
4. The merchant failed to send the merchandise or provide the service.
5. The merchandise was defective.
6. You received an incorrect amount from an ATM.

Question: Are there times when I would not file a formal notice of error and involve BankMobile?
Answer: Yes, of course. Many of the improper POS and ATM transactions can be resolved by contacting the merchant directly which
would not involve BankMobile. We would only become involved if the merchant was unresponsive. Even then, there may be times
when you would not contact BankMobile. Such as, when you are unhappy with the service or purchase, and yet, the reasons for your
dissatisfaction do not qualify as an error. We would recommend that you work with the merchant to resolve these issues.
For example:

1. When you authorized the transaction and are dissatisfied with the Quality of Service.
2. When you enter into a contract with the merchant and later wish to contest the terms of the contract.
3. When you authorized the purchase, received the product or service, and then experienced buyer’s remorse.
4. When you authorized the transaction in exchange for a gift or promotional offer and are unhappy with the agreement.

Question: I would like to report a transaction from an earlier statement. Is it too late?
Answer: MasterCard® rules and Regulation E provide for a specific window within which we can pursue a claim on your behalf. The
deadline for filing a claim is determined by the type of transaction in question. Card related claims may be initiated no more than
ninety (90) days from the date the transaction posted. Please refer to the date of the transaction to determine if your claim is timely.

Question: What is the first step in reporting a POS or an ATM transaction if I authorized it and disagree with certain aspects
of it?
Answer: If you authorized the transaction yet disagree with the amount or other aspects of it, we suggest that you first contact the
merchant to resolve the issue. If your attempt to resolve this with the merchant fails, you may initiate a formal claim with us.

Question: I contacted the merchant in an attempt to resolve the error. However, the merchant was not helpful. Now what?
Answer: The next step is to complete a written statement! If you have contacted the merchant and attempted to resolve the error
and are still dissatisfied, please continue with your claim. Complete the Written Statement on the following pages.

Return by US Mail: BankMobile Card Services - ATTN: Dispute Dept, PO Box 543000 Omaha, NE 68154 Page 2 of 4
or upload file via FAQ
 Written Statement

Improper POS or ATM Activity

Name:_____________________________________________________
Physical Address: _____________________________________________________
City, State, Zip: _____________________________________________________
Current Phone Number: _____________________________________________________
Card Number: _____________________________________________________
Merchant Name: _____________________________________________________
Dollar Amount: $ _____________

Claim Number: ______________ Please enter the claim number for your transaction.

Note: Only 1 transaction may be claimed on this form. To report multiple transactions, please request to report each
transaction individually and complete a separate form for each transaction.

I state that I examined my statement or other notification for my BankMobile account indicating that a debit entry
was charged to my Account _____________, on _______________, 20_____ in the amount of $___________,
and that the debit was improper due to the following:

(Please check all that apply and explain in detail):

□ The merchant debited my account for an incorrect amount.

(Please indicate the amount you authorized and the date you contacted the merchant in an attempt to resolve the
problem. Provide proof of the authorized amount and proof of merchant contact.)

□ The merchant debited my account on a date other than the one I authorized.
(Please indicate the date you authorized the transaction to occur and the date you contacted the merchant in an
attempt to resolve the problem. Provide proof of the date of authorization and proof of merchant contact.)

□ The merchant debited my account too many times.

(Please indicate the date(s) the debits occurred and the date(s) you contacted the merchant in an attempt to
resolve the problem. Provide proof of your authorization for the debit(s) and proof of merchant contact.)

□ The merchant failed to send or provide the merchandise or service as agreed.

(Please provide information regarding the original agreement and the date you contacted the merchant in an
attempt to resolve the problem. Provide documentation that substantiates the agreement and proof of merchant
contact.)

□ I contacted the merchant to cancel this service/product.

(Please provide proof of cancellation and proof of merchant contact.)

□ I received an incorrect amount of funds from my ATM withdrawal.

(Please provide the amount you expected and the amount you received. Attach a copy of the ATM receipt as
proof.)

□ This is an unauthorized charge.

I certify that i did not authorize or participate in this transaction with the above mentioned merchant, nor did I authorize anyone
else to use my card. Your card must be cancelled immediately for this type of fraudulent activity.

□ Other ______________________________________________

Page 3 of 4
Return by US Mail: BankMobile Card Services - ATTN: Dispute Dept, PO Box 543000 Omaha, NE 68154
or upload file via FAQ
 Written Statement

Improper POS or ATM Activity

We want to help you! Please provide specific details and the supporting documents such as purchase
receipts, merchant correspondence, proof of returned merchandise, proof of service or contract
cancelation, a copy of the terms and conditions of a signed contract, or a copy of the ATM receipt, for
any box that is checked. Remember, your supporting documentation and the information you provide is
used to resolve the error with the merchant on your behalf. Consequently, your documentation plus
clear, concise, and detailed answers will help us to resolve the error timely.

Please explain in detail (include dates & times):

____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

BankMobile is authorized to release any and all information regarding this notice of error to law enforcement
and other individuals or entities, if applicable and necessary.

I further state that the transaction was not originated with fraudulent intent by me nor by any person
acting in concert with me, and that the signature below has not been altered or changed. The
signature is representative of the signature used by me to sign all legal documents. I further state that
I have included the information and documentation to support the notice of error.

I certify under penalty of perjury that the foregoing is true and correct.

Name: ____________________________________ Date: ______________

(Please Print)

Signature: ____________________________________
(Please Sign)

Return by US Mail: BankMobile Card Services - ATTN: Dispute Dept, PO Box 543000 Omaha, NE 68154 Page 4 of 4
or upload file via FAQ
If multiple transactions are being disputed from the same merchant;
Please fill out specific information here:

MERCHANT NAME:

CLAIM number:
DOLLAR AMOUNT OF
DATE OF TRANSACTION: or
TRANSACTION:
FAQ Support Ticket number: