Refund form for cardholders

Titel*

Transaction Details

Transaction date*

Name and address of the merchant with which the transaction was conducted:

Transaction slip*
Copy of credit card statement* or account statement in the case of debit cards

 

With sending this form you confirm that:

1. you have answered this form truthfully and completely;

2. you have read in entirety, understood and accepted the “General business conditions for the DCC exchange rate guarantee” attached to this form.

All fields marked with * are mandatory.