How to Fill Out and Submit the Chase Statement of Dispute Form

The Chase Statement of Dispute Form is the written notice Chase uses to document a billing error investigation, and to submit it correctly you fill in every field using the exact merchant name, transaction date, and dollar amount shown on your statement, attach copies of any supporting receipts or correspondence, and return it to the billing inquiry address printed on that same statement within 60 days of the statement date.¹

When Chase Sends You the Form

Chase typically issues the Statement of Dispute Form after you have already opened a dispute by phone at 1-866-564-2262 or through the online portal at chase.com. It is the written record that formally triggers Fair Credit Billing Act protections. Even when your dispute began with a phone call or an online submission, a completed written notice is the method the statute specifically recognizes, so the form matters even if the investigation has already started.

The form asks you to identify yourself and your account, describe what went wrong, and specify the exact charge you want investigated. Federal law requires those three elements for any billing error notice: your name and account number, a description of the error, and the type, date, and amount of the charge in question.¹ Everything else on the form exists to help Chase’s investigator understand the context.

Filling Out the Form Field by Field

Consistency between the form and your billing statement prevents processing delays. Pull the statement showing the disputed charge and keep it next to you while you complete each section.

Account holder name and account number: write these exactly as they appear on your statement, including any middle initial or suffix.
Merchant name: copy the merchant name as printed on the statement, not the name you know the business by. If Amazon appears as “AMZN Mktp US,” use “AMZN Mktp US.”
Transaction date: use the posting date shown on the statement, not the date you made the purchase, unless the form specifically asks for the purchase date.
Dollar amount: enter the amount to the cent, matching the statement line exactly. A dispute over a partial amount (say, one duplicate charge out of two) should state the disputed portion clearly.
Reason for dispute: check the box or write the description that matches your situation. The recognized categories are unauthorized charge, wrong amount, duplicate posting, goods or services not received, goods not as described, missing credit for a return or payment, and a math or accounting error on the statement itself.
Description of the problem: write a short factual account. Include when you first noticed the issue, whether you contacted the merchant, and what response you received. Stick to facts and dates.
Signature and date: sign and date the form. An unsigned form can be rejected or delayed.

If the form has fields you cannot complete because the information does not exist (for example, no tracking number for goods that never arrived), write “N/A” rather than leaving the field blank. Blanks invite follow-up questions; explicit non-answers do not.

Special Notes for Goods-or-Services Disputes

When you are disputing a charge because a product never arrived or was not as described, federal law requires you to make a good-faith attempt to resolve the problem with the merchant before asserting the claim against Chase. There are also two thresholds: the initial transaction must exceed $50, and the purchase must have occurred in your home state or within 100 miles of your mailing address. Those limits fall away if the merchant is controlled by or affiliated with Chase, or if the transaction came from a mail solicitation Chase participated in.² Note on the form what you did to try to resolve the matter with the merchant and how the merchant responded.

Documents to Attach

Getting the form in on time matters more than assembling a perfect evidence package, but organized documentation strengthens the investigation and can shorten it. Chase’s guidance emphasizes receipts, photos, and any communication showing you attempted to work things out with the merchant.³

What to include depends on the type of dispute:

Wrong amount: the original receipt showing the price you agreed to.
Duplicate charge: the statement line for both postings, circled or highlighted.
Goods not received: the order confirmation, any shipping notification, and tracking information.
Goods not as described or damaged: photographs and copies of email exchanges with the merchant.
Cancelled service still being billed: the cancellation confirmation and the date it took effect.
Unauthorized charge: a brief note stating you did not make the purchase and did not authorize anyone else to use the card.

Arrange the attachments in chronological order so the investigator can follow the sequence from purchase to problem to statement. Send copies only. Never mail originals, because documents submitted with a dispute may not be returned.

Where and How to Submit It

Send the completed form to the billing inquiry address printed on your Chase credit card statement. That address is different from the payment address, and using the wrong one can delay or invalidate the notice. If a fax number is provided on the form or the back of your statement, faxing is acceptable, but mail with proof of delivery gives you the cleanest record.

Use certified mail with return receipt requested. The receipt establishes the date Chase received your notice, which is what matters for the 60-day deadline. That deadline runs from the date Chase transmitted the first statement containing the disputed charge, not from the transaction date, and once it passes Chase is no longer legally obligated to investigate under the Fair Credit Billing Act.¹ If you are close to the deadline, mail the form first with whatever documentation you have, then follow up with additional evidence.

Keep a full copy of everything you send, along with the certified mail receipt and any tracking confirmation.

What Happens After Chase Receives the Form

Chase must send written acknowledgment within 30 days of receiving your billing error notice, unless the bank resolves the dispute entirely within that window. The investigation must be completed within two billing cycles and no longer than 90 days, ending with either a correction to your account or a written explanation of why the charge stands.⁴

While the investigation is open, you do not have to pay the disputed amount or any related finance charges, and Chase cannot try to collect that portion of your balance. You are still responsible for paying the undisputed portion on time.⁵ If you are enrolled in autopay, Chase must stop deducting the disputed amount so long as your written notice arrived at least three business days before the scheduled payment date. Chase also cannot report the disputed amount as delinquent to any credit bureau while the investigation is pending.⁶

You can track the status through the online portal by opening the Account Menu, selecting “Account Services,” and choosing “Track Claims.”

If Chase Denies the Dispute

A denial arrives as a written explanation of why Chase believes the charge was correct. You can request copies of the documentary evidence the bank relied on, and Chase must provide them.¹ The letter will state the amount you now owe and give you at least your normal grace period (or 10 days, whichever is longer) to pay it without additional finance charges.

If you still believe the charge is wrong, send Chase another written notice within the payment window stating that the amount remains in dispute. Chase can then report the balance as delinquent, but only if the bank simultaneously reports the amount as disputed and gives you the name and address of every party it notified. If the matter is later resolved in your favor, Chase must report that resolution to every party it previously informed.⁶ Beyond that, you can file a complaint with the Consumer Financial Protection Bureau at consumerfinance.gov/complaint; the CFPB forwards it to Chase, and companies generally respond within 15 days.⁷

1
Consumer Financial Protection Bureau. 12 CFR 1026.13 – Billing Error Resolution
2
Office of the Law Revision Counsel. 15 USC 1666i – Assertion by Cardholder Against Card Issuer
3
Chase. How to Dispute a Credit Card Charge
4
Office of the Law Revision Counsel. 15 USC 1666 – Correction of Billing Errors
5
Federal Trade Commission. Using Credit Cards and Disputing Charges
6
Office of the Law Revision Counsel. 15 USC 1666a – Regulation of Credit Reports
7
Consumer Financial Protection Bureau. Submit a Complaint