Merchant Fee Request for Refund

Merchant Fee Request for Refund

If you received a letter in the mail stating that you may be eligible to have certain merchant-imposed fees refunded as the result of a returned non-sufficient funds item, please follow the instructions below to submit your request.

What you’ll need to get started:

  • Access code from letter
  • Social Security Number
  • Account number
  • Details of the check or ACH returned item
    • check number (not applicable for ACH)
    • who the item was made payable to
    • amount of item
    • date the item was returned
  • Merchant fee amount
Please fill out the form below for each item that you are requesting to be refunded. If you have multiple items to be refunded, please fill out a separate form for each item.
Click to begin refund request