Confirm Adjustment |
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Customer Name Sample Company A |
Customer Contact Name Jane Smith |
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Address 1 1234 River St. Address 2 |
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City Chicago |
State IL |
Zip Code 12345 |
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Phone Number 555-123-4567 |
Extension |
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Fax Number (United States number only) 555-234-5678 |
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Email Address first.last@companya.com |
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Adjustment Amount
$5,000.00
Credit
U.S. Bank Account to be Adjusted
123456789012 - Sample Account A
Your Reference Number
1234005000
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Item listed as 20,000.00 |
Item should be listed as 25,000.00 |
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Error Date 11/07/20XX |
Sequence Number 234567890 |
Deposit Date / Transaction Date
11/07/20XX
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Deposit Total / Transaction Total $100,000.00 |
Bundle Total |
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Previous Item $20,000.00 |
Next Item $150,000.00 |
Additional Information
Attach Document
Check_Copy_25,000.00.jpg
Deposit_Ticket.doc
SinglePoint Demo
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