How to fill up payoneer disput form?

I have lost some money on payoneer. I talked with them and they sent me a message with a file. They told me to fill up the form and send it back to them. But i don't know the real process. so please help me.

 

All you need to do is fill out this form and send it back to us and we file the dispute for you. If there are any parts of the forum that are unclear to you, feel free to contact me and I will help you.

 

Hello, thanks for supporting me Mr. David S. I need your help now. so how can i contact you? I am not clear more thing of that form. Should i fill up all part of the form by hand?
My uncleared Parts:

Transaction Number
Merchant Name
Date of Cancellation: ____________________
Expected Receiving Date of the Merchandise/Service _____________________
Merchandise / Service Details: ______________________________
Reason of Cancellation: ______________________________
Date of Last Contact with Merchant after the Transaction: ______________________________
Merchant’s Response: ______________________________
Additional Comments: __________________________________________
_________________________________________________________________
Date: ______________________________
Signature (hand written):

Thanks
sakil

 

Hey,

You can contact me at , please include the email associated with your Payoneer account in your email.