Service Request for Third-Party Audit or Risk Assessment

Service Request for Third-Party Audit or Risk Assessment
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
What prompted you to contact us about our services? (Choose one)

EmailPostcard/letter/direct mailConference or other eventReferred by my financial institutionPrior use of audit servicesEPCOR WebsiteOther
Please answer the following questions to determine your pricing:
What Services are you interested in?

ACH AuditACH Risk Assessment
ACH Services
Do you have internal Origination, (i.e. AP/AR, service fee collections)?

YesNo
How many Originators does your company provide services to?
How many Third-Party Senders does your company provide services to?
What are your preferred timeframes?

(Please list 3 dates or timeframes that work best for you.)
Timeframe option 1
*Dates subject to availability
Timeframe option 2
*Dates subject to availability
Timeframe option 3
*Dates subject to availability
Are you interested in learning more about Remote Audit Services, where either part or the whole service is performed via a secure electronic format?

YesNo
Has your company had any of the following changes since last audit?

Merger/AcquisitionCritical staff turnoverReport of Possible Rules Violation from Nacha
Comments
Should be Empty: