Mercantile Dispute Form - Please provide your contact information so that we may contact you directly with regard to your dispute

Description - Please be as through as possible with your dispute so that we may better assist you: (required)

Reference Number (If Available) (required)

First Name (required)

Last Name (required)

Phone Number

Email (required)

Verify Email (required)

I Agree to the Terms and Conditions and Privacy Policy. (required)

I acknowledge that by providing my phone number or email address, I consent to Mercantile communications through that medium. SMS message frequency may vary. Message & data rates may apply. Reply STOP to opt-out of further messaging. Reply HELP for more information. (required)