Fee Refund Request Form
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
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
625 Flormann St.
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.