Approval and Adverse Action Receipts for Check Cashing and Deposit

XYZ MERCHANT
12345 MAIN STREET
ANYTOWN, USA 12345
(123) 456-7890
May 14, 2024 02:38PM
CHECK: $100.00
SALE: $100.00
Approval #: xxxxxxxx
Certegy REF#: xxxxxxxxxxxxxxx

THANK YOU,
ANY QUESTIONS, Call
(Insert Merchant Phone Number 1-XXX-XXX-XXXX)
MERCHANT COPY

Check Cashing and Deposit Adverse Action Receipt

XYZ MERCHANT
12345 MAIN STREET
ANYTOWN, USA 12345
(123) 456-7890
May 14, 2024 02:38PM
CHECK: $100.00
SALE: $100.00
Certegy REF#: xxxxxxxxxxxxxxx
BANK: 036110011
ACCT: ******1298
CHK #: 1123

We’re sorry, but we are unable to proceed with your transaction. Our decision was based in whole or in part on information obtained from Certegy Payment Solutions LLC (“Certegy”). Certegy provides authentication and risk management services to merchants and businesses nationwide.

Certegy did not make the decision to take the adverse action and is unable to tell you the specific reasons why the adverse action was taken by us.

Under the Fair Credit Reporting Act, you have the right to obtain a free copy of your information held in Certegy’s file, if you request it no later than 60 days after you receive this notice. In addition, if you find that any information in Certegy’s file is inaccurate or incomplete, you have the right to dispute it with Certegy.

You may reach Certegy at www.askcertegy.com; toll free at 1-800-637-5747 or write to Certegy Payment Solutions, LLC, P.O. BOX 908, Grand Junction, CO 81502