Report of Lost Credit Card
This is a credit cardholder's report of a lost credit card. The form provided here is simply a sample of what the actual form looks like.
CARDHOLDER'S REPORT OF LOST CREDIT CARD
TO: __________(1)_____________
__________(2)_____________
Since receiving the ___________(3)_____________ issued under the
Number __________(4)___________, it has been lost. I lost the card
on or about _______(5)__________, ____(6)____.
The card was lost under the following circumstances:
(Describe Situation)
I notified ___________(7)________________ by telephone of the loss of the card
On ________(8)___________, ____(9)____.
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.
_____________(10)______________