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Important
Note:
Forms are to be used as a guide only to assist you. No liability is assumed for errors in substance or form. It is your responsibility to revise the forms to meet current law
requirements and your particular situation. No liability is assumed for improper use of these forms.
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CARDHOLDER'S
REPORT OF STOLEN CREDIT CARD
TO:
_________________________
_________________________
Since receiving
the __________________________ issued under the number
_______________________,
it has been stolen. The card was stolen on or about _____________, 19_____.
The card was
stolen under the following circumstances:
(Describe
Situation)
I notified
_____________________________ by telephone of the theft of the card on
______________________,
19_____.
You are hereby
authorized to take all steps necessary and to notify the appropriate
authorities to
avoid illegal use of the above-numbered credit card.
____________________________
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