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Direct Dispute 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; and
  • All supporting documentation or other information reasonably required by the bank to substantiate the basis of the dispute. This documentation should include (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

Please fill out the online form below and submit. If you prefer you may also fill out the form, print then mail or fax it.

For any further questions you may contact our Compliance Officer by calling 920.485.3040 or emailing

Mail To

Horicon Bank
Attn: Compliance Officer
326 E. Lake St.
PO Box 126
Horicon, WI 53032-0126

Fax To


Direct Dispute Online Form

* indicates required fields

Consumer #1
Consumer #2
Dispute Details

E.g. You were rejected for a credit card and the reason was a late payment.

Once you are contacted regarding your dispute you will be asked to submit all supporting documentation verifying your dispute.

Form Validation

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