CARDHOLDER'S REPORT OF LOST CREDIT CARD




TO:  _______________________  

       _______________________  
 
	

Since receiving the ________________________ issued under the number 

_____________________, it has been lost. I lost the card on or about _________________, 

19_______.  

	

The card was lost under the following circumstances: 

(Describe Situation) 

	

I notified ___________________________ by telephone of the loss of the card on 

___________________, 19______.  

	

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.  

                                 

_________________________ 


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NOTICE: The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. We recommend that you seek professional legal counseling before entering into any contract or agreement.