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Credit / Debit Card Abuse Self-Reporting Form
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Reportee / Victim Information
Financial Institution Information
Name of Institution
Bank Employee Name
Bank Phone Number
Credit / Debit Card Number
Fraudulent Transaction Information
Date, Time, Amount, Location of Transactions
I have read the statement below and will supply the information. Type yes in the space provided.
If your credit/debit card was used without authorization, a copy of the transaction history/credit card statement AND a Fraud Affidavit MUST be provided at the time this form is submitted. All forms can be emailed to addresses listed below.
Mail to: Sherman Police Department, 317 S. Travis, Sherman, TX 75090; or
Fax to: 903-892-7188; or
Email to: email@example.com
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