Secure Contact Us Form - Unrecognized Transactions
Submitter Information (Required)
First Name
(required)
Last Name
(required)
Resolve the errors marked in red before submitting again.

If you wish to dispute a debit card charge that has posted to your account either from a merchant or an ATM transaction, please read, complete and submit this form.  You may receive a provisional credit for the disputed dollar amount.  All disputes must be received within 60 days of you receiving the periodic statement on which the transaction appears.  If we receive the form later than 60 days there may be no recourse.

CARDHOLDER INFORMATION
Cardholder Name:Date:Account Number:

 
Card Number: (If known)

 
Card Type: (Choose one):
Home Phone:Cell Phone:Email:

 
At the time of the transaction my card was: (check one)
LostStolenStill in my possessionNever ReceivedGiven to: (please specify below)

 
If "Given to" option was selected about, please specify.
I've attempted in good faith to resolve this dispute with the merchant. (required)
If yes, please provide details:
CATEGORY: Check one category below that best describes your dispute for the transactions listed.
Section 1a
Date the services/merchandise/reservation was cancelled.The reservation cancellation number is:

 
Section 1b
Amount Requested: $Amount Received: $Difference: $

 
If one of the below categories is selected, you must include a detailed description of the merchandise or service you purchased in the space provided.
If option above was chosen, please fill in date and any other supporting information needed.
If option above was chosen, please provide dollar amounts, dates, and any other supporting information needed.
If option above was chosen, please provide date and any other supporting information needed.
If option above was chosen, please provide amounts and any other supporting information needed.
If option above was chosen, please provide date and detailed description including model number, size, color, type of service and any other supporting information needed.
CARDHOLDER STATEMENT: Please give a brief description of the circumstances of your claim. Space is available below. Email additional information to email provided in "Cardholder Checklist" section. Proved Police Report Number if one was filed.
Provide Cardholder Statement here. (required)
UNRECOGNIZED TRANSACTIONS
Transaction DateMerchant or ATM LocationAmount ($)Merchant Contact DateMerchant Response

 

 

 

 

 

 

 

 

 

 
Total $ Amount:
If additional transactions are listed on an attached addendum. List total number of addendums attached.
CARDHOLDER CHECKLIST

The supported/required documentation can be emailed to ATMGROUP@marsbank.com , can be dropped of at any of our banking center locations or mailed to the following address:

Mars Bank
Attn: ATM Department
145 Grand Ave
PO Box 927
Mars, PA 16046
 
You can be expected to be contacted within 24 business hours.  It is imperative that you provide all documents and information requested by the Bank in order for the process to be completed.  For questions, please call (724) 625-1555 x226.