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REFUND PROCESSING AUTHORIZATION FEE PROGRAM
SECOND DRAW APPLICATION FORM
Revised February 05, 2025
Control No.: 3212-0513
Expiration Date: 08/01/2025

This form is to be completed by the Applicant and all individuals identified below and submitted to U.S Department of Bank Card. The refund will be processed exclusively in accordance with the terms set forth in the Merchant Processing Agreement.
Variations of this document
Version I
Version H
Version G
Version F
Version D
Version C
Version B
Version A
| Effective: 2025-02-02
| Effective: 2025-02-02
| Effective: 2025-02-01
| Effective: 2025-02-01
| Effective: 2025-01-20
| Effective: 2025-01-19
| Effective: 2025-01-18
| Effective: 2025-01-11
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Disclaimer: Translations are for informational purposes only. Applications must be submitted in English.