Submit Adjustment

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To submit an adjustment, complete the fields, attach the necessary documents and click Continue.

* = required


Customer Information
Customer Name
Sample Company A 		Customer Contact Name
Jane Smith

Address 1


Address 2
  

City
   
 State
 Zip Code

Phone Number

 Extension

    

Fax Number (United States number only)

  

Email Address
  

Adjustment

Adjustment Amount*
$

U.S. Bank Account to be Adjusted*

Your Reference Number


Error Type*
Missing Bundle
Missing Cash Letter or Deposit
Enclosed NOT Listed (extra item)
Listed NOT Enclosed (missing item)
Extra Bundle
Extra Cash Letter or Deposit
Debit Read as Credit
Credit Read as Debit
Posted Twice (Duplicate)
Not Our Item (Ineligible)
Advice Request
Bad or Missing Image
Encoding Error
Item listed as*
    		Item should be listed as*
Other (Describe*)

Error Date*
(MM/DD/YYYY)
Calendar    		Sequence Number

Transaction Information

To further assist in locating the specific transaction to be adjusted, please complete all relevant fields.

Deposit Date / Transaction Date
(MM/DD/YYYY)
Calendar

Deposit Total / Transaction Total
$       		Bundle Total
$      

Previous Item
$       		Next Item
$


Additional Information


Attach Document  

       Attach another document

Fax Document   Fax cover sheet


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SinglePoint Demo
Submit Adjustment lets you submit a new adjustment request.

Hint: Click Auto-Fill, then click Continue.

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