Customer Contact Center

Report of Unauthorized Transactions

Claim ID: 0002936456

ID-0002936456
Date: 10/12/2016

Customer Name DEBRA K JONES Primary Phone: (317) 717-3410

Customer Address 6052 E 21ST ST APT 2A Secondary Phone: N/A
Customer City State ZIP INDIANAPOLIS, IN 46219

I am disputing the following transaction(s) for card number ending in ******5820 that is identified on the
accompanying list of unauthorized transactions.

I currently have possession of the card I do not have possession of the card
Date discovered missing

Last authorized use occurred on 10/08/2016 at Regions

In the amount of $200.00

The card or card number was provided to

On and was returned on

Additional people with knowledge of the PIN/Secret Code Number:

Has a police report been filed? NO Case #:

Police Department: Contact Name:

Additional Comments:

I did not use, nor authorize anyone else to use, the card identified above for any transaction
identified on accompanying list;
None of the proceeds from any transaction were applied to any use or purpose on my behalf,
and I did not receive any other value or benefit from any transaction;
I have made available to Regions any knowledge, ideas, suspicions or other information that
I may have about the identity of the person who wrongfully used my card, and will make
available any such additional information I may gain the future. I agree to assist and
cooperate fully with any investigation related to these transactions, whether by federal, state,
local or bank investigators, including testifying before a grand jury or in a court of law against
the party responsible for the unauthorized use of my card.

Form 54057 Distribution: ORIGINAL Customer

Rev 10/2015 Copy - RCPC
Customer Contact Center

List of Unauthorized Transactions

ID-0002936456
Transactions on card number ending in ******5820 ; Claim ID 0002936456 :

Merchant Name Date Amount Merchant Name Date Amount

TU *TRANSUNION 09/13/2016 1.00 TU *TRANSUNION 10/09/2016 19.95

Please review this report to confirm its accuracy. If you identify any inaccuracies in the report, please notify
the branch or call the telephone number on your card and provide the Claim Number shown above.

Regions will investigate this dispute report and make a determination, generally within 10 business days from
the date of this report. If a provisional credit for the disputed amount is issued to the account, all fees
associated with the identified transaction will be waived at the time of provisional credit.

If you have supporting documentation related to this dispute, you should submit that documentation, along
with this report, to Regions Bank as soon as possible. Please keep a copy of the report and supporting
documentation for your records. The report may be submitted at any Regions Bank branch, or sent to Regions
Bank at:
Fax: Mail:
205-261-5438 Post Office Box 413, Birmingham, AL 35201

For your security, please make sure that all references to the card number on any supporting documentation
include only the last four digits of that number.

Form 54057 Distribution: ORIGINAL Customer

Rev 10/2015 Copy - RCPC