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CARDHOLDER'S REPORT OF STOLEN CREDIT CARD



TO:  __________(1)_____________  



       __________(2)_____________  



	Since receiving the ___________(3)_____________ issued under the number 

__________(4)___________, it has been stolen. The card was stolen on or about 

_____(5)______, 19__(6)_.  



	The card was stolen under the following circumstances:  



(Describe Situation) 



	I notified ____________(7)_______________ by telephone of the theft of the card on 

________(8)____________, 19__(9)_.  



	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.  



                                  ___________(10)_______________ 





NOTICE



	The information in this document is designed to provide an outline that you can follow 

when formulating business or personal plans.  Due to the variances of many local, city, county 

and state laws, we recommend that you seek professional legal counseling before entering into 

any contract or agreement.