Cardholder's Report Of Stolen Credit Card
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:
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.