CARDHOLDER'S REPORT OF LOST CREDIT CARD
Since receiving the ___________(3)_____________ issued under the number
__________(4)___________, it has been lost. I lost the card on or about _______(5)
The card was lost under the following circumstances:
I notified ___________(7)________________ by telephone of the loss of the card on
You are hereby authorized to take all steps necessary and to notify the appropriate
authorities to avoid illegal use of the above-numbered credit card.
The information in this document is designed to provide an outline that you can follow
when formulating business or personal plans. Due to the variances of many local, city, county
and state laws, we recommend that you seek professional legal counseling before entering into
any contract or agreement.