Report of Stolen Credit Card
This is a credit cardholder's report of a stolen credit card. The form provided here is simply a sample of what the actual form looks like.
CARDHOLDER'S REPORT OF STOLEN CREDIT CARD
TO: __________(1)_____________
__________(2)_____________
Since receiving the ___________(3)_____________ issued under the
Number __________(4)___________, it has been stolen. The card was stolen
on or about _____(5)______, ____(6)____.
The card was stolen under the following circumstances:
(Describe Situation)
I notified ____________(7)_______________ by telephone of the theft 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)_______________