Contact Information | BMO Financial Group

BMO MasterCard Balance Insurance reimbursement request

Please complete this form to allow us to process your reimbursement request. This information is required to ensure we match you to our records. Information collected will be used solely to process this refund. A cheque will be mailed to the address you provide below.

Please note the following fields are required fields. Please complete them and re-submit your form.

*All fields are mandatory.

First Name:

Last Name:

Date of Birth:

Phone Number:

Street Number and Street Name:

Apt/Unit:

City:

Country:

Province/Territory:

Postal/Zip Code:

Note: Please enter n/a if not applicable.

For assistance, please call a BMO Bank of Montreal representative at 1-800-263-2263.