Member FDIC - Equal Housing Lender

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ATM Error Form
Submitter Information (Required)
First Name
Last Name
Resolve the errors marked in red before submitting again.
Contact Information
Phone Number:Email Address:

Mailing Address

We will not update our records with this information. If this information needs updated, please submit an "address/contact change form".

Contact Preference
If we have questions about this form, how would you like us to contact you? (required)
Dispute Information
Debit/ATM Card Number:
Transaction Date:
Select the appropriate error:
The amount on the account statement is:
Amount Received was:
Please list any additional details:

I attest that the above information is true and correct to the best of my knowledge. I understand that I will be notified within 10 (ten) business days of the above date regarding a determination on this matter.