Cardholder's Report Of Stolen Credit Card
TO: __________(1)_____________ __________(2)_____________ Since receiving the ___________(3)_____________ issued under the number __________(4)___________, it has been stolen. The card was stolen on or about _____(5)______, 19__(6)_. The card was stolen under the following circumstances: (Describe Situation) I notified ____________(7)_______________ by telephone of the theft 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:
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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.