Stripe Dispute

Dispute Details

Amount

Payment Date

Payment Method

Stripe Reference

Business Details

Business Name

Billing Address

Country

Address Line 1

Address Line 2

City

State

Zip / Postal Code

Products or Service Details

Description

What type of product or service is this?*

Shipping Address

Checkbox - Shipping addr same as billing

Same As Billing Address

Country

Address Line 1

Address Line 2

City

State

Zip / Postal Code

Tracking Info (Optional)

Tracking Number

Carrier

Shipping Date

Cancellation

Reason 1

Reason 2

Refund

Refund Reason 1

Refund Reason 2

Supporting Evidence

Submit accurate and relevant high-resolution documents to support your case.

Form Completed By

Name

Company/Branch