Southeast Corporate -- Virtual Deposit Adjustment Form

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All required fields have an asterisk ( * ).

Credit Union Information

*CU Name:

*CU Fax:

( xxx) xxx-xxxx

*R&T #:

Your Contact Information

*First Name:

*Last Name:

*Phone:

Extension:

Email:

Adjustment Information

Please Select Adjustment Type (Required)

Encode Error

Paid Twice

*Listed As:

Difference:

*Should Be:

*Virtual Deposit Date:

mm / dd / yy

Virtual Deposit Date:

mm / dd / yy

*Trace #:

Trace #:

(Paid Twice - 2nd presentment Information)

* Reason for Adjustment

Debits or Credits

Debit Adjustment:

Credit Adjustment:

NOTE: Southeast Corporate no longer accepts Debit or Credit Adjustments $25.00 and under. This is in compliance with the Federal Reserve Bank change effective February 14, 2005.