Direct Dispute Form

Simply Fill out this Form

Horicon Bank will investigate a dispute made by a consumer when the dispute contains the following information:

  • Sufficient information to identify the account or other relationship that is in dispute, such as an account number and name, address and telephone number of the consumer, if applicable
  • The specific information that the consumer is disputing and an explanation of the basis for the dispute
  • All supporting documentation or other information reasonably required by the bank to substantiate the basis of the dispute, including (as applicable):
    • a copy of the relevant portion of the consumer credit report that contains the allegedly inaccurate information (including the name of the credit reporting agency)
    • a police report
    • a fraud or identity theft affidavit
    • a court order
    • account statements
    • cancelled checks
    • receipts verifying payments

Direct Dispute Online Form

Account Type
Select the information you will provide as documentation. (Once you are contacted regarding your dispute, you will be asked to submit all supporting documentation verifying your dispute.)
For Validation

Download the Direct Dispute Disclosure.

For any further questions, contact our Compliance Officer at 920-485-3040 or

Some content requires Adobe Acrobat Reader to view.