Writing the Chargeback Reversal Agreement (Stronger) document
CREDIT CARD CHARGEBACK REVERSAL AUTHORIZATION.
Visa [ ] MasterCard [ ] Discover [ ] American Express [ ] Other:
Note: The merchant, "Company Name" has obtained sufficient tracking information for this transaction and will provide a rebuttal to the credit card issuer. The merchant reserves the right to request further investigation or refer the chargeback to the proper authority should a signature from the customer not be acquired. This transaction chargeback was reported in error.
I (the "Cardholder") agree to the reversal of the chargeback.
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.