ATM Questionnaire

Which of the following would you like to report?

I had an issue while using my card at an ATM.

Tell us about the reason behind the dispute.

I had an issue withdrawing funds at an ATM.

Did you receive more funds than the posted amount?
- No
- Yes — This will result in a debit to your account for the difference between the withdrawal amount and dispensed amount. Do you wish to proceed with this dispute?
  - No
  - Yes
How much money did you receive from the ATM?
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
Did you receive more funds than the posted amount?	Yes/No	Mandatory
How much money did you receive from the ATM?	Freeform Text	Mandatory
This will result in a debit to your account for the difference between the withdrawal amount and dispensed amount. Do you wish to proceed with this dispute?		Conditional	When “Yes” to “Did you receive more funds than the posted amount?”
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 ATM deposit posted for the wrong amount.

Did the transaction post for an amount greater than the deposited amount?
- No
- Yes — This will result in a debit to the account.
What is the correct deposit amount?
Do you have a receipt?
- No
- Yes
Please provide the location of the ATM:
- Crossroads
- Street Address
- Street Address #2
- City
- State
- Zip
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
Did the transaction post for an amount greater than the deposited amount?	Yes/No		Mandatory
This will result in a debit to the account.			Conditional	When “Yes” to “Did the transaction post for an amount greater than the deposited amount?”
What is the correct deposit amount?	Freeform Text		Mandatory
Do you have a receipt?	Yes/No		Mandatory
Please provide the location of the ATM:	Freeform Text	Crossroads Street Address Street Address #2 City State Zip	Mandatory	All fields are optional
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 ATM deposit did not post to my account.

What was the date of the deposit?
What did you deposit?
- Cash — What was the total amount deposited in cash?
- Check — Enter the following information about each check that was deposited. You may enter up to 30 checks per ATM deposit claim.
  - Check Amount
  - Maker
  - Check Number
  - Date
- Both —
  - What was the total amount deposited in cash?
  - Enter the following information about each check that was deposited. You may enter up to 30 checks per ATM deposit claim.
    - Check Amount
    - Maker
    - Check Number
    - Date
What were the last 4 digits of the card used?
Was this transaction performed at a ATM?
- No —
  - Which institution did the ATM belong to?
  - Please provide the location of the ATM:
    - Crossroads
    - Street Address
    - Street Address #2
    - City
    - State
    - Zip
- Yes — Please provide the location of the ATM:
  - Crossroads
  - Street Address
  - Street Address #2
  - City
  - State
  - Zip
Do you have a receipt?
- No
- Yes
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
What was the date of the deposit?	Date		Mandatory
What did you deposit?	Single Select	Cash Check Both	Mandatory
What was the total amount deposited in cash?	Freeform Text		Conditional	When “Cash” or “Both” is selected
Enter the following information about each check that was deposited. You may enter up to 30 checks per ATM deposit claim.		Check Amount Maker Check Number Date	Conditional	When “Check” or “Both” is selected
What were the last 4 digits of the card used?	Freeform Text		Mandatory
Was this transaction performed at a ATM?	Yes/No		Mandatory
Please provide the location of the ATM:	Freeform Text	Crossroads Street Address Street Address #2 City State Zip	Conditional	When “Yes” to “Was this transaction performed at a ATM?” All fields are optional
Which institution did the ATM belong to?	Freeform Text		Conditional	When “No” to “Was this transaction performed at a ATM?”
Please provide the location of the ATM:	Freeform Text	Crossroads Street Address Street Address #2 City State Zip	Conditional	Follows “Which institution did the ATM belong to?” All fields are optional
Do you have a receipt?	Yes/No		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?”