Free cardholder report of a stolen credit card form that you can print

TO: ______________________

_______________________

Since receiving the _______________________ issued under the number _____________________, it has been stolen. The card was stolen on or about ___________, 20___.

The card was stolen under the following circumstances:

(Describe Situation)

I notified ___________________________ by telephone of the theft of the card on ____________________, 20___.

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.

__________________________