Fill and Sign the After Notice Form

Credit Cardholder's Report of Lost or Stolen Credit Card After Notice by Telephone To: ________________________________ ________________________________ ________________________________ ________________________________ Re: ___________________ (Loss and/or Theft) of Credit Card Number __________________ (give credit card number) TO WHOM IT MAY CONCERN: On ______________________ [date that credit card was issued] , you issued to me the above described credit card in the name of _______________________________ (name of card holder) . As I notified you by telephone on _________________ (date of telephone notice) , the credit card was _____________ ( lost and or stolen) on ________________ (date of loss or theft) , at approximately (time of day) . The ___________________ (loss and/or theft) of the card occurred _____________________________________________________ (location of loss and/or theft or estimated vicinity of location). (If appropriate): The theft (or loss of card) was reported to the following authorities: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (list names of authorities that the theft and/or lost card was reported to, such as police departments, sheriff’s departments, etc.). Please take all steps necessary, and notify the appropriate authorities, in order to avoid illegal use of the above-numbered credit card. Dated: _________________ ________________________________ Signature