Form for return of wire by 8O7FdJE


									                           Gateway Account Correction Form

                                  All fields are required.
            Email completed form by 4:00 p.m. ET to

            Note: Email’s received after 4:00 pm ET will be processed the next business day.

              Agency Name:

              Requested by:

             Phone Number:

TRS Source Financial Transaction ID
CA$HLINK II Message Audit Number:
          Type of Transaction:                                         ACH             Wire
          Date of transaction:
(Correction requests will only be honored for
transactions made on or after Sept. 13th 2010)
             Dollar amount:

        Original ALC credited:
      Gateway account credited:
     (8 digit ALC# or 12 digit account #)
        Reason for Correction:

  For payments credited to incorrect Gateway Account, please provide correct
                              Gateway Account.
     Correct Gateway Account:
     (8 digit ALC# or 12 digit account #)

                             For Credit Gateway internal use only
          Must be approved by listed agency contact from PCD 55867, or excel spreadsheet.

 Date received:                                            By whom:

  Approved by
(Agency Contact                                        Call Tracker Ref.
assigned through                                            Number
 Sent to Gateway
                                                     Customer Care Rep:
    Ops Date:

 Date completed:

                                         V 1.1 10/21/2010

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