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ACH Reversal Request Form

This document provides a form and instructions for requesting reversals of Automated Clearing House (ACH) transactions. The form collects information about the company, transaction details, and reason for the reversal request. Reversals must be submitted within 5 days of the initial transaction to comply with NACHA rules.

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Rei Himura
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687 views

ACH Reversal Request Form

This document provides a form and instructions for requesting reversals of Automated Clearing House (ACH) transactions. The form collects information about the company, transaction details, and reason for the reversal request. Reversals must be submitted within 5 days of the initial transaction to comply with NACHA rules.

Uploaded by

Rei Himura
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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For Internal

Use ONLY:

ACH REVERSAL REQUEST FORM


NOTICE: Per the NACHA Operating Rules, ACH Originators who transmit reversing entries to correct erroneous credits or debits are required to notify the
Receiver that the reversal is being transmitted, including the reason for the reversal. Reversals are to be received by the Receiving Bank no later than 5
banking days after the settlement date of the initial entry. M&T can request a reversal from the Receiving Bank; however, the Receiving Bank is not obligated to
honor the request.

For inquiries, please contact the Commercial Service Team at (800) 724-2240, Monday-Friday,
8am-6pm ET. To request an ACH Reversal or Deletion, fax completed form to 1-877-359-9853.
Requests received after 4pm ET may be considered next banking day's business.

Company Name Date

Contact Name

Company Account Number

Phone Number Fax Number

Authorized Signature

Is this request a result of fraud? Yes No


CST: If this request is a result of fraud, please escalate to PE and ACH Operations.

Transmission Method: Web Info/Web InfoPLU$ Direct Transmission (MFT or FTM)

*For Pass Thru Files, please include sample transaction information

Reverse the following: Transaction File/Batch

Individual Name (for Receiver Account Number (for File/Batch or Transmission Credit or
Number Effective Date
Transaction only) Transaction only) Transaction Amount Date Debit

Reason for Request/Special Instructions:

INSTRUCTIONS FOR COMPLETING ACH REVERSAL REQUEST FORM:


• The ACH Reversal Request Form is designed to assist you with a request for special handling of previously originated erroneous entries or files that have been submitted to M&T for
processing.
• If the Form is missing necessary information or contains invalid information, there will be a delay in processing.
• M&T will delete the entry/file if it has not been released into the ACH Network. If the entry/file has already been released, M&T will create a REVERSAL transaction (e.g., the opposite of
your original entry) on your behalf in an attempt to recover/disburse funds.
• The ACH Reversal Request Form must be submitted to M&T no later than 4 days after the settlement date so that M&T can notify the Receiving Bank before the deadline set by the
NACHA Operating Rules.
• Any deletions or reversals will be posted on your ACH Activity Reporting the business day following submission of this Form to M&T. At that time, for credits, M&T will provisionally
refund the amount of the entry/file until the Receiving Bank approves or rejects your request for a reversal.
• It should be noted that M&T will make a best effort attempt to recover the transactions requested, but the Receiving Bank is not obligated to honor your request. The provisional amount
paid by M&T for credits is conditioned on the Receiving Bank’s approval of your Reversal request and will be deducted from your account if the Receiving Bank declines to process the
reversal transactions.
Please note: M&T can request a reversal from the Receiving Bank; however, the Receiving Bank is not obligated to honor the request.
For inquiries, please contact the Commercial Service Team at (800) 724-2240, Monday-Friday, 8am-6pm ET.

© 2019 M&T Bank. Member FDIC.

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