<%@ Language=VBScript %> Electronic Check Recovery

CHEXpedite Electronic Check Recovery Bank Release

Merchant's Bank Name:  
 
Bank Contact Name:  
 
Bank Address:
CityStateZip
Bank Phone Number Bank Fax Number
 

TO WHOM IT MAY CONCERN:

 
I/We hereby authorize and instruct you to mail all return items after first presentation for payment and determination of uncollectable funds to CHEXpeditetm Electronic Check Recovery. It is important that you forward these items after the first presentation; do not attempt to present each item a second time.
 
Please Remit All Returned Items To:
 

XpressCheX, Inc.
P.O. Box 1927
Albuquerque, NM 87103-1927

 
This new address and authorization applies only to return items and is to remain in effect until cancelled in writing. Please mail duplicate copy of "Return Deposit Item" notice to Merchant
 
Bank Routing Number (9 digits)
Bank Account Number
 
Name of 1st Authorized Signor on the Account Name of 2nd Authorized Signor on the Account
Title Date Title Date
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Merchant Account Name:  
 
Contact Name:  
 
Address:
CityStateZip
Phone Number Fax Number
 
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