Cardholder's Report Of Stolen Credit Card

TO: _______________________



Since receiving the ________________________ issued under the number____________________, it has been stolen. The card was stolen on or about ___________, 201(x).

The card was stolen under the following circumstances:


(Describe Situation)


I notified ___________________________ by telephone of the theft of the card on ___________________, 201(x).


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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