Merchant & Merchandise Related
Transactions Dispute Form

Instructions

Complete this form in its entirety
Email any supporting documentation via Contact Us

Before you begin, please note the quickest and easiest way to resolve a claim is to contact the merchant directly.

Account details

Card type *

Cardholder Name *First and last

Bluevine sign-in email *

Card number *Last 4 digits

Account Number *This is the account number listed on your monthly statement

Dispute Transactions Details

Transaction Date *

Date contacted Merchant *or date attempted to contact the merchant

Merchant Name *As it appears on the statement

Transaction Amount *

Dispute Amount *

Additional transactions detail (if applicable) **If you are disputing more than one transaction, please add the details of the additional transactions below. If you are disputing more than 5 transactions, please email a copy of your card transaction history highlighting the disputed transactions via dispute.support@bluevine.com

Reasons for Merchant Dispute

Please select only one of the following dispute boxes and email any supporting documents you may have to support this claim. See the end of the form for documentation guidelines.

Select *

Cardholder Summary of Dispute

Provide a detailed summary of the dispute, including specific description of merchandise, what was promised, what was received, what the merchant stated when they were contacted or any other relevant information that can support this claim.

Cardholder Summary **Note: This information may be used to support your claim with the merchant, and card network. Please do not include sensitive information such as your social security number or date of birth.

Supporting Documentation Guidelines

Providing supporting documents can help increase your chances of being awarded credits for your disputed transactions. Please email any supporting documentation via Contact Us.

Relevant documentation can include:

Proof of cancelation
Tracking numbers for returned goods
Invoice showing description of goods
Invoice or receipt showing correct amount billed
Proof paid via another means
Credit receipt issued by the merchant showing card number, date of refund, and amount
Any merchant communication showing you attempted to resolve this matter

By clicking here, you confirm that the information provided is accurate to the best of your knowledge. *

Merchant & Merchandise Related Transactions Dispute Form

Instructions

Merchant & Merchandise Related
Transactions Dispute Form