Unauthorized Electronic Transaction

    Complete one form for each unauthorized transaction. You have 60 days from receiving your account statement to notify us of an unauthorized electronic transaction on your account. Even if you tell us orally about an unauthorized transaction, you must submit a written or electronic form to confirm your claim. Once submitted, the Bank will investigate your claim within 10 business days, or provisionally credit your account the amount in dispute. Within 45 days, we will conclude our investigation and either:

    1. notify you your provisional credit is final OR
    2. reverse the provisional credit if we deny the claim

Customer Information

  • OKFirst Name is required
  • OptionalOKMiddle Initial is required
  • OKLast Name is required
  • Social Security Number

    --
    OKSocial Security Number is required
  • Date of Birth

    OKDate of Birth is required
  • OKEmail is required
  • OptionalOKMother's Maiden Name is required

Address Information

  • OKStreet is required
  • OKCity is required
  • OKState is required
  • OKZip is required
  • Cell/Home Phone

    --
    OKCell/Home Phone is required
  • Work Phone

    --
    OKWork Phone is required

Account Information

  • OKAccount Number is required

Electronic Transaction Information

  • OKCard Number is required
  • Please be aware, reporting an unauthorized card transaction will cause your current card to be immediately disabled. A new card should be ordered through the Debit / ATM Card Application form. Lost or stolen cards should be reported as soon as possible. Contact your branch or call (978) 458-7999. After Hours, please call (800) 554-8969.

  • Have you lost your card?

    OKHave you lost your card? is required
  • Date you noticed your card was missing

    OKSpecify a date

 

    Please be aware, many of these types of transactions are because of auto payments that customers have with merchants, like a gym membership. We will refute this transaction on your behalf, but if the merchant can prove there is a payment agreement with you, the claim will be denied. If you do not who this merchant is, we may have to close this account and open a new one to protect you from such transactions in the future.

 

    We will return this deposit to the processor.

Type of Dispute

  • Please select one

    OKPlease select one is required

 

  • OKAmount authorized is required
  • OptionalOKComments is required

 

    Please be aware this transaction is not unauthorized, but a civil matter between you and the merchant. You have protections under the MasterCard brand from such purchases and we will place the claim on your behalf, but no conditional credit of the amount in dispute will be given.

  • OKWhen was the order placed? is required
  • OptionalOKComments is required

 

    Please be aware this transaction is not unauthorized, but a civil matter between you and the merchant. You have protections under the MasterCard brand from such purchases and we will place the claim on your behalf, but no conditional credit of the amount in dispute will be given.

  • OKWhen was the order placed? is required
  • OKHow were the goods different than expected? is required

 

  • OKWhen was the order placed? is required
  • OKWhy did you revoke the order? is required

 

  • Do you still have your card?

    OKDo you still have your card? is required
  • Did you give your card and PIN to another person to use on your behalf?

    OKDid you give your card and PIN to another person to use on your behalf? is required
  • OKAmount authorized is required
  • Do you know the name of this person?

    OKDo you know the name of this person? is required
  • OKName of Person is required
  • OptionalOKAddress of Person is required
  • OptionalOKCity is required
  • OptionalOKState is required
  • OptionalOKZip is required
  • Phone of Person

    --
    OptionalOKPhone of Person is required
  • OptionalOKRelationship is required
  • Will you prosecute this person?

    OK Will you prosecute this person? is required
  • Have you filed a police report?

    OKHave you filed a police report? is required

Description of Transaction

  • Date of Transaction

    OKDate of Transaction is required
  • OKMerchant Name is required
  • OKDollar Amount is required
  • OptionalOKAdditional Comments is required

Security Code

  • OK is required
  • OKSignature is required
  • OKMother's Maiden name or Account Code is required
  • Please read this written statement carefully. You are cautioned that knowingly giving a false statement may subject you to criminal prosecution. You may be required to file a police report at your local police station and provide Washington Savings Bank a copy along with filing this written statement.

    I swear that this written statement is true and understand that making a false sworn statement is subject to federal and/or state statutes and may be punishable by fines and or imprisonment. This written statement is true and correct. Your information will be encrypted when using this form while in transit between your browser and Washington Savings Bank. All information is submitted securely through SSL certificate and 256-bit encryption, e-signature signed in accordance with the ESIGN Act.

    SIGNATURE(S) – By signing this signature card, the undersigned acknowledges receipt of the Terms and Conditions governing this account and agrees to be bound by said Account Agreement. The authority of each account owner have the right, power, and authority to sign checks and other instruments, close the account, sign other related agreements such as the Online Banking Enrollment/Agreement, obtain account information and initiate transactions through the Bank Customer Center, and request account maintenance when necessary. Joint Accounts are considered Tenants with Rights of Survivorship (JTWROS).