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First Lockhart National Bank

Personal Online Banking Login

Phone: 512-398-3416 | Routing Number (ABA) 114903213

Unauthorized Debit

Cardholder Information
Dispute Information
Claim Circumstances
Merchants and Amounts
  • Step 1

    Cardholder Information

    * Indicates Required

    • Card Type*
    • Unauthorized Usage Location*
    • Card Closed*

      *Required for Unauthorized Use

  • Step 2

    Dispute Information

    * Indicates Required


    Unauthorized Use

    I, the undersigned claimant declare, as appropriate that:

    I did not use, nor authorize anyone else to use, the ATM or Debit Card issued to me by First Lockhart when said card was used to withdraw funds from my account at the Bank; or

    I did not receive any value or benefit from proceeds of the card transaction(s) and no proceeds were applied to any use or purpose on my behalf; or

    I have not arranged with the person(s) who misused the card to be reimbursed for proceeds of the card.

    Furthermore, I have made available all knowledge, ideas, or suspicions, if any, or the identity of the person who wrongfully used my card and will make available any such knowledge gained in the future and agree to assist and cooperate fully, without limitation, with any investigation pertaining to this matter, whether by federal, state, local, or bank investigators, including testifying before a grand jury or in a court of law against the party responsible for the improper or unauthorized use of the ATM or Debit Card. I hereby certify by signing below that the above information is true and correct.


  • Step 3

    Claim Circumstances

    * Indicates Required

    Customer Did Not Participate in Transaction(s) or Lost/Stolen

    • Is card still in your possession?*
    • Have you ever allowed anyone to use the card?*
    • Was the PIN/Secret Code number with the card?*
    • Was a police report filed?*

    ATM Withdrawal Dispute

    Which situation best describes your dispute?

    Dispute with Merchant - Customer Originally Participated in Transaction(s)

    Any requested documentation is required for MasterCard to process your claim (i.e. receipts, proof of return, etc.)

    • Have you attempted to resolve your dispute with the merchant?*
    • Specify one
    • Please check the ONE category that best describes your dispute.

      Attach a copy of (a) the cash receipt, or (b) the front and back of canceled check, or (c) the copy of the other receipt.

      Attach a copy of sales slip or invoice.

      Attach a copy of the credit slip.

      I did authorize the purchase, however:

      Attach a letter of explanation

      Attach proof of return

      Attach copies of correspondence with merchant.

      Attach corredpondence

      Supporting Documents

      Accepted formats: .pages, .doc, .docx, .pdf, .png, .jpg
      Select files from your computer
      or simply drag & drop them here
  • Step 4

    Merchants and Amounts

    * Indicates Required

    Date Merchant Amount ($)

    You should expect resolution or provisional credit in accordance with the provisions and disclosures set forth in your card agreement.