Cardholder's Report Of Lost Credit Card
Since receiving the ___________________________ issued under the number ________________________, it has been lost. I lost the card on or about ___________________, 20______.
The card was lost under the following circumstances:
I notified ______________________________ by telephone of the loss 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.