Re-Debit Reject Exception Request For Ach Rules Compliance
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1Re-Debit Reject Exception Request
For ACH Rules Compliance
If account information was entered incorrectly (i.e.: xx45 instead of xx54),
simply correct and re-debit. Submission of this form is not required.
Requests will be completed within 3 banking days. Please plan accordingly.
Date of Request: _____________________ SPS MID#: __________________________
Company Name: _________________________________________________________
Contact Name: ___________________________ Phone: _______________________
Email: __________________________________________________________________
Account Holder Name: ____________________________________________________
Bank Routing #: _____________________ Account #: ___________________________
EEDate of Previous Returned Transaction: ____________________
Return Date: ________________________
Return Code: __________
Select One:
One Time Entry
OR
All Future Debits
Return due to wrong account type entered (Savings vs. Checking)?
Yes
No
Comments: ______________________________________________________________
1) What to submit with the request:
Submit a copy of new ACH authorization provided in writing by the account holder, including
if the new authorization is for a one-time entry or for all future debit entries.
2) Where to submit the request:
-
Use SPS secure email at
to send this form and
accompanying documents to .
OR
- Fax to 858-549-1323 (ATTN: Compliance) and call 888-313-7842 to confirm the fax was
received.
3) Completion confirmation:
Confirmation is emailed to the contact name & email address given above.
DO NOT EMAIL
Re-Debit Reject Exception Request forms & authorization docs.
Use Secure Email OR Fax ONLY for security reasons.
ACH Rules Compliance Reminder
NACHA Operating Rules prohibit a re-initiation entry to the same account where the prior
entry was returned for any reason other than R01 ( NSF) or R09 (Uncollected Funds), unless
the account holder has acknowledged in writing (dated and signed) that the transaction has
been resolved, and such re-debit authorization has been successfully forwarded to and input
by SPS for subsequent action.
SPS INTERNAL USE ONLY: Completed by:
Date:
Secure Payment Systems, 10650 Scripps Ranch Blvd, 109, San Diego, CA 92131
888-313-7842
Fax 858-549-1323
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