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Statement of Unauthorized Electronic Fund Transfer (EFT) Activity - $25.00

Table of Contents

Form Instructions
Section 1 - Customer Information
Section 2 - ATM, Point of Sale, Debit or Payroll Card Was Involved
Section 3 - Unauthorized Debit Entry Only
Section 4 - Improper Debit Entry Only
Section 5 - Stop Payment of Future Transactions
Section 6 - Authorization and Acknowledgement Statement
Notary Information
Bank Use Only

The purpose of this Statement of Unauthorized Electronic Fund Transfer Activity Form Template is to be used by financial institution personnel to provide a form to customers for completion in the event they report unauthorized electronic fund transfer (EFT) account activity.  This Statement of Unauthorized Electronic Fund Transfer Activity Form Template (approximately 3 pages) is available to purchase from BankPolicies.com in Microsoft® Word format for $25.00

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