Form Rec

CARDHOLDER ASSISTANCE REQUEST
Name/Nombre: PAULA FERNANDA ÁVILA ESTÉVEZ

Account Number/Numero de tarjeta: 4048370003993470
The charge(s) appeared on my billing statemente as/ El cargo(s) aparecen en mi estado de cuenta como:
Post Date/Fecha Proceso Tran Date/ Fecha tran Merchant/Establecimiento Amount /Monto
19/2/2024 01.39.06 MOVISTAR ARENA CAP.FEDERA 26,81
19/2/2024 01.39.07 MOVISTAR ARENA CAPITAL FE 4,02
Choose the one category which best describes your situation. Use aditional sheets to provide more information or comments.
Escoja una categoria que describa la situación de su reclamo. Use hojas adicionales para proveer mas información o comentarios
MERCHANDISE/SERVICE NOT RECEIVED-MERCADERIA/SERVICIO NO RECIBIDO :
I did not receive merchandise or services which were to be delivered on /No recibo de mercaderia o servicio que debio ser entregado en:
YY____MM____DD____
SERVICE CANCELLED- SERVICIO CANCELADO notifying merchant by-notifica al establecimiento:

I canceled service or insurance coverage on YY____MM____DD___
Servicio o cobertura de seguro cancelado en: phone mail person other
A copy of my cancel letter is enclosed. Adjunto copia de carta de cancelación
CANCELLED HOTEL RESERVATION/ RESERVACION DE HOTEL CANCELADA notifying merchant by-notifica al establecimiento:
I canceled this hotel reservation on/ Cancele la reservación en : YY______MM_____DD______
Cancellation number is/ Número de cancelación _______________ . phone mail person other
RECURRING TRANSACTION CANCELLED- TRANSACCIONES RECURRENTES CANCELADAS :
I canceled service on/ Cancele el servicio en : YY______MM_____DD______
notifying merchant by-notifica al establecimiento:
phone mail person other
MERCHANDISE NOT AS DESCRIBE OR DEFECTIVE MERCHANDISE-MERCADERIA NO COMO LO DESCRITO O DEFECTUOSA
Provide details-Proveer detalles:
Merchandise returned-Mercedería devuelta YES NO YY____MM____DD____

CREDIT NOR RECEIVED/ CREDITO NO RECIBIDO
The merchant agreed to credit my account, enclosed is a copy of credit slip or the merchant's written promise of credit.
Establecimiento acordo emitir crédito a mi cuenta, adjunto copia de recibo de crédito o carta de comercio
X UNAUTHORIZED NOT PARTICIPATE ON TRANSACTION/ NO AUTORIZADA NI PARTICIPA EN TRANSACCION
I did not authorize or participate on this transaction- No autoriza ni participa en transacción
DOUBLE BILLING- TRANSACCION DUPLICADA :

I authorized only one transaction, but two or more charges were billed to my account.
Autoricé una transacción, dos o mas transacciones fueron facturadas en mi cuenta
NON RECEIPT OF CASH ATM- DINERO NO DISPENSADO CAJERO AUTOMATICO

Cardholder participate on transaction and did not received cash or received partial amount
Tarjetahabiente participo en la transacción y no recibio el dinero o recibio monto parcial
PAID BY OTHER MEANS - PAGADO POR OTROS MEDIOS:
I paid for this charge by cash, check or another credit card. Enclosed is a copy of cash receipt, check or other credit
card statement.- Pago en efectivo, cheque u otra tarjeta de crédito. Adjunto copia del recibo de pago, cheque o estado de cuenta.
INCORRECT AMOUNT-MONTO INCORRECTO
I was billed for US$ , but the correct amount is US$ . Enclosed is a copy of credit card receipt.
Valor facturado por US monto correcto es Adjunto copia de recido de transacción.
WHAT SERVICE OR MERCHANDISE YOUR EXPECTED TO RECEIVE - QUÉ SERVICIO O MERCADERÍA ESPERABA RECIBIR
Detail
Detalle:
WHAT DATE DID YO EXPECT TO RECEIVE THE SERVICE OR MERCHANDICE AND, IF THAT IS THE CASE, WHEN DID YOU CANCEL IT?
QUÉ FECHA ESPERABA RECIBIR EL SERVICIO O MERCADERÍA Y SI ES EL CASO CUANDO LA CANCELÓ
To Receive:YY____MM____DD____ I Cancel YY____MM____DD____

Recibir: AA____MM____DD____ Canceló: AA____MM____DD____
YOU TRIED TO SOLVE THE PROBLEM WITH THE ESTABLISHMENT AND WHAT ANSWER DID YOU GET
USTED INTENTÓ SOLUCIONAR EL INCONVENIENTE CON EL ESTABLECIMIENTO Y QUÉ RESPUESTA OBTUVO
YES NO SI NO
Establishment response
Respuesta del establecimiento:
OTHERS- OTROS :
Declaro conocer la responsabilidad la tenencia y utilización del plástico de la tarjeta, así como de los datos y claves de la misma registradas en platatorma digitales como por ejemplo: Glovo, Uber, Google, Apple, facebook, etc.
I declare to know the respoinsibility, the possession and use of the plastic of the credit card as well as the data and keys of the same registered in digital platforms such as: Glovo, Uber, Google, Apple, facebook, etc.
This form is just a transaction requirement. The cases solutions are subject to Rules.
Cardholder Signature: Date: 23/2/2024

Firma de Tarjetahabiente Fecha:

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CARDHOLDER ASSISTANCE REQUEST

Name/Nombre: PAULA FERNANDA ÁVILA ESTÉVEZ

SERVICE CANCELLED- SERVICIO CANCELADO notifying merchant by-notifica al establecimiento:

Merchandise returned-Mercedería devuelta YES NO YYMMDD

DOUBLE BILLING- TRANSACCION DUPLICADA :

NON RECEIPT OF CASH ATM- DINERO NO DISPENSADO CAJERO AUTOMATICO

To Receive:YYMMDD I Cancel YYMMDD

Cardholder Signature: Date: 23/2/2024

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