This form is not to be used to report Fraud. If you believe you have had unauthorized or fraudulent transactions on your account, please call the credit union at (605) 342-7776 at your earliest convenience.

We want to move quickly to protect your account.

This form is to provide a means to explain why you believe the credit union has unfairly or mistakenly charged a fee for services provided.

Please complete the form and mail it to:

MED5 Federal Credit Union
ATTN: Operations
4956 5th Street
Rapid City, SD 57701

We will review your request and determine if a refund is appropriate given your circumstances.

If a refund is granted, we will credit your account and send you a receipt in the mail.

Please Complete the Form Below

  • OK Name is required
  • OK Date of Fee Transaction(s) is required
  • OK Total Fees Charged is required
  • OK Why do you feel MED5 should refund the fee(s)? is required


    OK I understand that submitting this form does not guarantee that MED5 will refund the fees in question, if they are found to be valid fees. is required
  • OK is required