Organization *

Check Here if Third-Party Sender/Third-Party Service Provider

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City *

State *

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Postal Code *

Country *

Enter required value United States Canada Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo Democratic Republic of Cook Islands Costa Rica Coted Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island and Mc Donald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isleof Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Democratic Peoples Republic Korea Republic of Kuwait Kyrgyzstan Lao Peoples Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands British Virgin Islands US Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Sark

First Name *

Last Name *

Title *

Phone *

Email *

CHECK HERE

If contact information is the same as above

First Name

Last Name

Title

Phone

Email

First Name

Last Name

Title

Phone

Email

Service Year Requested

ACH and Risk Assessments

ACH Audit

ACH Risk Assessment

Third-Party ACH Audit

Third-Party ACH Risk Assessment

Number of ACH Originators

Pricing for ACH Audit and ACH Risk Assessment is based on the number of ACH Originators/Third-Party Senders.

Number of Third-Party Senders

Instead of a select sampling of Originators for review, we prefer a review of all Originators. Please know this may require additional onsite days, see consulting services on the next page for additional details. 

SEC Codes Originated

RDC

RDC Assessment & Audit of Internal Controls

RDC Methods Offered:

Teller/Branch Capture

Mobile Capture

ATM Capture

Merchant Capture

Number of Merchant Capture Customers

Pricing for RDC service is based on number of merchant customers.

Number of Merchant Mobile Customers

Instead of a select sampling of Originators for review, we prefer a review of all Originators. Please know this may require additional onsite days. Continued pages provide additional details.

Wire

Wire Transfer Audit of Additional Controls

Average Monthly Wire Volume

Pricing for wire service is based on methods and complexity. 

(enter value, not dollar amount)

Wire Methods Offered

Email

Phone

Fax

In-Person

Online Banking/Cash Management

Must comply with Regulation E, Subpart B

Instead of a select sampling of Originators for review, we prefer a review of all Originators. Please know this may require additional onsite days; see consulting services on the following page for additional details. 

Yes

Real Time Payments (RTP)

Pricing for the RTP service is based on receiving or originating activities.

Real Time Payments (RTP) Participant Audit

Customer Review - Sound Business Practices and Internal Controls *

NUMBER OF CUSTOMERS TO BE REVIEWED

Review Financial Institution's Internal Controls - Due Diligence, Onboarding, Policies, & Procedures

PAYMENT TYPE

Consulting Service *

Yes

Describe Consulting Request *

Pricing for consulting services is an hourly rate. Description of services are listed above. Not seeing what you need, mark Custom Consulting and provide a short description of the needed review. 

Please Review:

CHECK HERE if interested in having services completed remotely

CHECK HERE if interested in signing a multiple year services contract. Two and three year contracts are available. PaymentsFirst will contact you to discuss details of multi-year services contract

CHECK HERE if you are only requesting a proposal. Please provide an email address to which the service proposal should be sent

Preferred Month

Preferred Month for Services: Please list preferred months for requested services. PaymentsFirst will contact you shortly to schedule specific days for the month you requested service. Each service selected will take at least one day. Additional days may be needed depending on the complexity of the services you offer. When selecting your preferred months for service, please keep in mind that it will take approximately 45 banking days for final reports to be returned to you. Scheduling is based on a first-come, first-served basis. The third and fourth quarters book up very quickly. If you wait to schedule and want dates in the third or fourth quarter, likely, there will likely not be any available dates.

Please provide your 1st Choice, 2nd Choice, and 3rd Choice Below: