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E-Check Consumer Receipts

CashLine E-Check Approval and Adverse Action Receipts

Consumers have the right to decline signing the approval receipt in view of the service fee, in this case a VOID transaction would be submitted.

XYZ MERCHANT
12345 MAIN STREET
ANYTOWN, USA 12345
(123) 456-7890
May 14, 2024 02:38PM
CHECK: $100.00
SALE: $100.00
ACH REF ID: XXXXXXX
Approval #: xxxxxxxx
Certegy REF#: xxxxxxxxxxxxxxx
BANK: 036110011
ACCT: ******1298
Current Limit: $1000.00
Available Limit: $500.00
Available Limit Reset Date & Time: Jan 1, 2024 at 6:17am
Available Limit Reset Timeframe: 6 days
Settlement Date: ‘Next Day’ or ‘Settlement date’

By signing below, you authorize Certegy and/or the Merchant to use the information from your check to make a one-time electronic funds transfer (EFT) or bank draft from the account listed above for the amount of the check, or to process this payment as a check transaction. The debit will usually occur within twenty-four (24) hours of the date of the receipt. You may terminate this authorization by calling Certegy at the number below in such time as to afford Certegy and your financial institution a reasonable opportunity to act on your request. Terminating this authorization does not affect your duty to pay your underlying obligation. You understand that this authorization is subject to applicable law and network rules.

If your payment is returned unpaid, you authorize Certegy and/or the Merchant to collect a Service Charge and/or the face amount of the check by EFT or using bank drafts from your account. The Service Charge will be $[xxxxxxx.xx].

YOU ARE ELECTRONICALLY SIGNING AND AGREEING TO THIS AUTHORIZATION AND AUTHORIZING US TO ELECTRONICALLY DEBIT YOUR ACCOUNT. YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO BE BOUND BY THE TERMS OF THIS AUTHORIZATION.

The Service Charge will be $[xxxxxxx.xx].

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

*Signatures are to be stored and saved for two years by the processor

XYZ MERCHANT
12345 MAIN STREET
ANYTOWN, USA 12345
Apr 20, 2024 9:30 AM

CHECK:
$100
SALE:
$100
ACH REF id:
xxxxxxxxxxx
Approval #:
xxxxxxxxxxx
CERTEGY REF:
XXXXXXXXXXXXXXXX
BANK:
036110011
ACCT: *****1298
Current Limit:
$1,000.00
Available Limit:
$500.00
Available Limit Reset Date & Time: Jan 1, 2024 at 6:30pm
Available Limit Reset Timeframe: 6 days
Settlement Date: ‘Next Day’ or ‘Settlement date’

By signing below, you authorize Certegy and/or the Merchant to use the information from your check to make a one-time electronic funds transfer (EFT) or bank draft from the account listed above for the amount of the check, or to process this payment as a check transaction. The debit will usually occur within twenty-four (24) hours of the date of the receipt. You may terminate this authorization by calling Certegy at the number below in such time as to afford Certegy and your financial institution a reasonable opportunity to act on your request. Terminating this authorization does not affect your duty to pay your underlying obligation. You understand that this authorization is subject to applicable law and network rules.
If your payment is returned unpaid, you authorize Certegy and/or the Merchant to collect a Service Charge and/or the face amount of the check by EFT or using bank drafts from your account. The Service Charge will be $[xxxxxxx.xx].
YOU ARE ELECTRONICALLY SIGNING AND AGREEING TO THIS AUTHORIZATION AND AUTHORIZING US TO ELECTRONICALLY DEBIT YOUR ACCOUNT. YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO BE BOUND BY THE TERMS OF THIS AUTHORIZATION.

______________________________________
Signed

IF YOU HAVE ANY QUESTIONS, CALL CERTEGY AT:
(Insert Certegy Phone Number 1-XXX-XXX-XXXX)
MERCHANT COPY

CashLine Adverse Action Receipt

XYZ MERCHANT
12345 MAIN STREET
ANYTOWN, USA 12345
(123) 456-7890
May 14, 2018 02:38PM
CHECK: $100.00
SALE: $100.00
Certegy REF#: xxxxxxxxxxxxxxx
BANK: 036110011
ACCT: ******1298

Certegy Payment Solutions, LLC (“Certegy”) provides authentication and risk management services to merchants and businesses nationwide.

Certegy did not make the decision to take adverse action and is unable to specify why we chose to decline the transaction.

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 within the next 60 days. Also, if you find that Certegy’s records are inaccurate or incomplete, you have the right to dispute them with Certegy.

You may reach Certegy at www.askcertegy.com; toll free at 1-833-293-3131 or write to Certegy Payment Solutions, LLC, P.O. Box 908, Grand Junction, CO 81502

XYZ MERCHANT
12345 MAIN STREET
ANYTOWN, USA 12345
Apr 20, 2024 9:30 AM

CHECK:
$100
SALE:
$100
CERTEGY REF#:
xxxxxxxxxxx
BANK:
036110011
Acct:
*****1295

We’re sorry, but we’re 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 didn’t 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 Certeegy’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 1-833-293-3131 or write to Certegy Payment Solutions, LLC, P.O. Box 908, Grand Junction, CO 81502.

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