Evidence Submission Form
Use this form to submit evidence to counter a credit card dispute. NOTE: All fields must be filled out completely. Incomplete or inaccurate information will result in processing delays. CourseStorm is not responsible for lost disputes as a result of delays due to missing or incorrect information.
Your Organization Name
*
Please enter the name of your program.
Your Name
*
First Name
Last Name
Your Email Address
*
Confirmation Email
example@example.com
CourseStorm Site URL
*
Please enter your complete CourseStorm site address (example: mysite.coursestorm.com)
Dispute ID
*
Please only enter one dispute ID at a time. Evidence for multiple disputed charges must be submitted separately.
File Upload(s)
*
Browse Files
Drag and drop files here
Choose a file
You may attach as many files as you wish. Each file should correspond to one of the Types below.
Cancel
of
Type of Evidence - Please select all that apply for the file(s) you've uploaded.
*
Customer communication (emails, text screenshots, etc.)
Customer receipt (copy of receipt for customer purchase)
Documentation of refund (check stub, email notification, etc.)
Documentation of service provided (attendance, certificate, etc.)
Refund or payment policy document
Customer signature/acknowledgment of policy
Other
Signature: I have reviewed my submission info above and confirmed it is complete and accurate.
Type your initials to confirm.
Please verify that you are human
*
Submit
Should be Empty: