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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)__________, 19__(6)_.
The card was lost under the following circumstances:
(Describe Situation)
I notified ___________(7)________________ by telephone of the loss of
the card on ________(8)___________, 19__(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)______________
NOTICE
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.
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