HAVE YOU EXPERIENCED DIFFICULTY USING YOUR CARD?

Please take a moment to complete and submit the secure form below.

Please note that all fields marked* are mandatory.

Reason *: Card swipe machine was not working
Merchant requested payment by:(Please select the appropriate reason)
Other card Cash
Merchant requested an additional amount for using the American Express® Card
Merchant requested a minimum amount for using the American Express® Card
Merchant told me about other payment methods but not the American Express® Card
There was no American Express®sign displayed, only signs for other cards
Comments:
In order for us to be able to respond fully to this issue, please provide as much detail as possible on the incident that occurred:
Date of Incident*
(dd/mm/yyyy):		 Time of Incident AM PM
Type of Business*
(e.g Restaurant): 		Other Business:
Name of Business*: Business Tel Number:
Location*: City/Town*:
Country*: Other Country:
Outcome*: How did you complete the transaction ?
Declined to Purchase
Other Card
Cash
Completed with American Express Card
Your Name:
Your Telephone number (inc Country Code e.g. +97317557777):
Submit this Form Now: