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)
*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 accepts Debit or Credit Adjustments $25.00 and under for Duplicate Items only. This is in compliance with the Federal Reserve Bank changes effective 2/14/2005 and 8/31/2009.