Mass Arb - Banks

Date

MonthDayYear
Date
Status Picklist
Matter Status Picklist
Source
Case Type
Company
medium
Name, Case Type, and Email
CreatedById
Party Record Type
Uses New Form Links

TRUE
Name*

First NameLast Name
Phone*
Please enter a valid phone number.
Personal Use Email*
example@example.com
Bank Account Number
Why do we need? Because to move forward with your case and prove to the Bank you are an account holder, we need to match your name with your account.
If you prefer, you can securely upload a bank statement showing us fees that you have been charged for us to review

Cancelof
Address*

Street Address

Street Address Line 2

CityState

Zip Code
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