Service Request for Audit and/or Risk Assessment

Address

Contact Name

First Name Last Name
E-mail
Phone Number

- Area Code Phone Number
Routing Number
How did you hear about our services? (Choose one)

Prior use of audit services EPCOR Website Email Marketing Conference Direct Mailing Word of Mouth/Referral
Please answer the following questions to determine your pricing:
What Services are you interested in?

ACH Audit ACH Risk Assessment RDC Risk Assessment
Do you have internal Origination, (i.e. loan payments, external ACH transfers)

Yes No
How many Originators does your FI provide services to?
How many Third-Party Senders does your FI 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?

Yes No
Has EPCOR provided on-site Audit Services to your FI within the past two years?

Yes No
Did your FI have any significant “Non-Compliant” findings on your most recent audit?

Yes No
Has your FI had any of the following changes since last audit?

Data processor change/ACH Software change Merger/Acquisition Critical staff turnover Report of Possible Rules Violation from NACHA
Comments
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