ACH Questionnaire

Is the issue you are reporting related to a transaction made with your debit card?

Which of the following would you like to report?

I did not authorize a debit or credit to my account

Have you or any authorized signer on the account ever done business with any of these disputed merchant?
- No
- Yes — Is it possible that this is a planned, recurring transaction, such as a monthly or yearly subscription?
  - No
  - Yes — Based on the information you provided we'll need to update the claim reason. Please click continue to proceed.
Do you have any additional information to provide about this dispute?
- No — Continue the procedure.
- Yes — Please provide any additional information.

Question properties

Question	Type	Requirement level	Notes
Have you or any authorized signer on the account ever done business with any of these disputed merchants?	Yes/No	Mandatory
Is it possible that this is a planned, recurring transaction, such as a monthly or yearly subscription?	Yes/No	Conditional	When “Yes” to “Have you or any authorized signer on the account ever done business with any of these disputed merchants?”
Based on the information you provided we'll need to update the claim reason. Please click continue to proceed.		Conditional	When “Yes” to “Is it possible that this is a planned, recurring transaction, such as a monthly or yearly subscription?”
Do you have any additional information to provide about this dispute?	Yes/No	Mandatory
Please provide any additional information.	Freeform Text	Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

I previously authorized a debit to my account, but since revoked the authorization.

Was this a recurring transaction?
- No
- Yes
What date did you revoke authorization?
How did you contact the merchant to revoke authorization?
- Email
- Mail
- Phone
- In-person
- Other
[Internal question: Is a stop-payment fee configured?]
- No
- Yes — We're sorry you're experiencing an issue with your account. A stop payment request may be applied to your account to prevent future debits associated with this revoked authorization from being approved. A fee of 25 USD will be charged for this service, and the stop payment may not take effect for up to 24 business hours. You may cancel this stop payment service at any time without incurring any additional fees.
Would you like to place a stop payment request?
- No
- Yes — A stop payment on this originating company will be in place for a period of 30 days.
Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Was this a recurring transaction?	Yes/No		Mandatory
What date did you revoke authorization?	Date		Mandatory
How did you contact the merchant to revoke authorization?	Multi-select	Email Mail Phone In-person Other	Mandatory
We're sorry you're experiencing an issue with your account. A stop payment request may be applied to your account to prevent future debits associated with this revoked authorization from being approved. A fee of 25 USD will be charged for this service, and the stop payment may not take effect for up to 24 business hours. You may cancel this stop payment service at any time without incurring any additional fees. Would you like to place a stop payment request?	Yes/No		Conditional	When a stop payment fee is configured
A stop payment on this originating company will be in place for a period of 30 days.			Conditional	When “Yes” to “Would you like to place a stop payment request?”
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

I authorized a transaction, but it is incorrect

Which of the following best describes the reason for your dispute?

My account was debited/credited before the date I authorized

Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

My account was debited/credited for an amount different from what I authorized

Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

My account was debited by a third party, but the third party failed to make the payment as instructed

Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

I was charged/credited more than once

Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

A debit/credit to my account that was previously returned was improperly reinitiated

Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

My check was improperly processed electronically.

Which of the following best describe the reason the check was improperly processed:
- The original check was already presented for payment.
- The amount of the transaction was not accurately obtained from the check.
- I opted out of the check conversion activity.
- The Originator did not provide notice in accordance with the NACHA ACH Operating Rules.
- The original check was improper.
  - Please select the appropriate reason below:
    - The signature on the original check is not authentic or authorized or the item has been altered.
    - The check not eligible to be processed electronically. or the item has been altered.
    - The check not eligible to be processed electronically
Do you have any additional information to provide about this dispute?
- No — Go to next question
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Which of the following best describe the reason the check was improperly processed:	Single Select	The original check was already presented for payment. The amount of the transaction was not accurately obtained from the check. I opted out of the check conversion activity. The Originator did not provide notice in accordance with the NACHA ACH Operating Rules. The original check was improper.	Mandatory
Please select the appropriate reason below:	Single Select	The signature on the original check is not authentic or authorized or the item has been altered. The check not eligible to be processed electronically. or the item has been altered. The check not eligible to be processed electronically	Mandatory
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

I am missing a direct deposit

Who sent the direct deposit?
What was the exact amount you were expecting to receive?
What date were you expecting this credit?
Do you know which account number this deposit was sent to?
- No
- Yes — What is the account number that the direct deposit was sent to?
  - Do you have the transaction trace number?
    - No
    - Yes — What is the trace number?
Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Requirement level	Notes
Who sent the direct deposit?	Freeform Text	Mandatory
What was the exact amount you were expecting to receive?	Freeform Text	Mandatory
What date were you expecting this credit?	Date	Mandatory
Do you know which account number this deposit was sent to?	Yes/No	Mandatory
What is the account number that the direct deposit was sent to?	Freeform Text	Conditional	When “Yes” to “Do you know which account number this deposit was sent to?”
Do you have the transaction trace number?	Yes/No	Mandatory
What is the trace number?	Freeform Text	Conditional	When “Yes” to “Do you have the transaction trace number?”
Do you have any additional information to provide about this dispute?	Yes/No	Mandatory
Please provide any additional information.	Freeform Text	Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”

I authorized a debit to my account, but there is a problem and I need to dispute it

Is this dispute in regards to merchandise or services not received?
- No
- Yes — Please describe what was purchased and any additional details about the transaction that will help us investigate your dispute.
Were you tricked or persuaded into authorizing this purchase?
- No
- Yes
Is this dispute in regards to a scam?
- No
- Yes — Was the scam related to a disaster?
  - No
  - Yes
- What entity did the scammer impersonate?
- Were you contacted by anyone requesting a payment?
  - No
  - Yes — Who initiated contact for this purchase?
    - I contacted the merchant to make this purchase.
    - I was contacted by the merchant to make this purchase.
- Please provide a detailed description of the scam.
Please provide a detailed description of your dispute.
Do you have any additional information to provide about this dispute?
- No
- Yes — Please provide any additional information.

Question properties

Question	Type	Values	Requirement level	Notes
Is this dispute in regards to merchandise or services not received?	Yes/No		Mandatory
Please describe what was purchased and any additional details about the transaction that will help us investigate your dispute.	Freeform Text		Conditional	When “Yes” to “Is this dispute in regards to merchandise or services not received?”
Were you tricked or persuaded into authorizing this purchase?	Yes/No		Mandatory
Is this dispute in regards to a scam?	Yes/No		Mandatory
Was the scam related to a disaster?	Yes/No		Conditional	When “Yes” to “Is this dispute in regards to a scam?”
What entity did the scammer impersonate?	Freeform Text		Conditional	Follows “Was the scam related to a disaster?”
Were you contacted by anyone requesting a payment?	Yes/No		Conditional	Follows “What entity did the scammer impersonate?”
Who initiated contact for this purchase?	Single Select	I contacted the merchant to make this purchase
I was contacted by the merchant to make this purchase	Conditional	Follows “Were you contacted by anyone requesting a payment?”
Please provide a detailed description of the scam.	Freeform Text		Conditional	Follows “Who initiated contact for this purchase?”
Please provide a detailed description of your dispute.	Freeform Text		Mandatory
Do you have any additional information to provide about this dispute?	Yes/No		Mandatory
Please provide any additional information.	Freeform Text		Conditional	When “Yes” to “Do you have any additional information to provide about this dispute?”