R&F — Cash Payment Compliance

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Step 1 Qualifying Transaction

Transaction Type

Customer Information

First Name

Last Name

3rd Party Making Payment (optional)

Home Address

City / State / Zip

Date of Birth

SSN or EIN

Occupation

Identification

Type of Photo ID

State Issuing ID

ID Number

Payment Details

Amount of Cash Payment ($)

Date of Payment

Associate Information

Associate Name

Store Location

Date of Form

Additional Notes (optional)

Live Email Preview

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To: Sue — Accounts Receivable

Subject: Cash Payment Compliance — [Customer Name]

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