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Get CITIBANK GOVERNMENT CARDHOLDER DISPUTE FORM

ANY INFORMATION/FORMS REQUESTED BELOW ALONG WITH THE STATEMENT THE DISPUTED CHARGE APPEARS ON. PLEASE FAX TO 605-357-2019 or MAIL TO Citibank Government Services, P.O. Box 6125, Sioux Falls, SD 57117-6125. This form must be filled out completely and forwarded to Citibank and the appropriate Agency officials (as determined by your internal procedures) within 60 calendar days of receipt of your invoice. TRANSACTION DATE: (5) DOLLAR AMOUNT OF CHARGE: $ (6) MERCHANT: (7) CARDHOLDER SIGNATURE:.

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