Refunds
Fill out all of the * fields accurately. Checks will be cut by Accounting Department on first day after allotment run posted.
* Required
ContractNo
*
Scheduled 1st Pmt Date
*
Date that first payment was due Format: mm/dd/yyyy
1st Pmt Rec Date
*
Check NAR to see when 1st payment was posted
StoreNo
*
120
125
135
140
145
150
160
170
175
185
190
430
142
105
Pmt Amt
Last Name
*
First Name
*
Address#1
*
Address#2
**Put Apt # Here
City
*
State
*
Two Letter Abreviation Only
Zip
*
Phone#
*
Choose a number which they can be reached
Acct Review
Accounting Dept Reviewer
Schedule Ck Date
Date Check will be Cut by Accounting Dept