Writing the Chargeback Reversal Agreement (Standard) document
CREDIT CARD CHARGEBACK REVERSAL AUTHORIZATION.
Visa [ ] MasterCard [ ] Discover [ ] American Express [ ] Other:
This transaction chargeback was reported in error. I (the "Cardholder") agree to the reversal of the chargeback. I also understand that with sufficient tracking information the merchant "Company Name" can provide a rebuttal to the credit card issuer without a signature from the customer and request further investigation.
Print and Fax this form to:
Company Name Attention: Sales Dept - Fax Fax Number.
Print and mail this form to:
City, State Postal Code
Important: Email, Adobe PDF, Email Faxes or other Electronic delivery of this form will NOT be accepted.