Complete the short questionnaire
below to help us provide the best customer experience.
* These fields are required.
Was this an online purchase/payment?*
Name of Merchant Business or website address*
Was this purchase made on a military base?*
State / Province*
Zip / Postal Code
Date of Visit*
Does the merchant offer Discover as a method of payment?*
Was the transaction attempted?*
Time of transaction attempt
Were you attempting to use a chip card?*
How was the chip card used with the card
Has the chip card been successfully used with
How was the chip card used with other
Back to your original referral, if you used a different card,
was the transaction successful at the merchant?
Was the other card that you used a chip card?
Please select all that apply about your
At checkout, did you:*
Checkout Type Comments
Was there a pin pad or any place to enter your
When you or the cashier swiped/inserted your card,
were you prompted or given the following payment options?
Please select all that apply.
What option did you select?*
After selecting Debit as your payment option,
were you prompted to: Please select all that apply.
If you selected get cash back, were you able to
successfully get cash back?*
What was the message displayed on the
Was the card previously accepted at this
Were there any Discover logos on the
merchant's door/register/website or payment choice at online
Issuing Financial Institution*
First 6 and Last 4 digits of your card*
Your card information will be used
solely for the improvement of this issue and will not be
shared outside of Discover card.
Please enter any additional
information regarding your experience which may help us
resolve this issue
Case Sensitive, No Spaces Allowed.
The information you submit on this
page will be used by Discover for internal business purposes
and not shared with third parties unless required by law.