Authorization To Close And Refund Prepaid Card Balances
Rapid Financial Solutions
Rapid Financial Solutions
Card Owner Name:
Birth Date:
Address:
City: St_____ Zip Phone:________________________
Social Security Number (last 4 digits) xxx-xx-
SignaturePrint Name:
:_____________________________________
:_____________________________________
Date
:______________________
I hereby authorize Rapid Investments, Inc dba Rapid Financial Solutions to send checks or originate ACH (direct
deposit) credit entries to the bank account at the depository financial institution named below.
The purpose is to refund balances remaining on prepaid debit cards. The name, address, partial Social Security number
and card number(s), are listed below as verification that I am the proper custodian of these funds.
I understand that receipt of funds by ACH (direct deposit) credit or check will release Rapid Financial Solutions of any
further obligation under the Terms and Conditions. I accept any applicable card closure fees. All fees are found on the
website located on the back of the card.
Recipient Bank Name:
Routing Transit Number (RTN)
Bank Account Number
Name of the owner of this Bank Account
ACH (Direct Deposit): Cost - Free
Refunds will be made to a valid U.S. bank account via ACH (direct deposit) credit within 3-7 business days of Rapid Financial
Solution’s receipt of this form.
If you are requesting an ACH (direct deposit) Credit to a US bank account please check here:
Email:_________________________
Paper Check: Cost - See Terms and Conditions
If you would like your refund to be sent as a paper check to the Card Owner’s address listed above, please
allow up to 15-21 business days from Rapid’s receipt of this form for your refund check to arrive.
Attn:
State: Zip:
To whom should the check be made out:
What address should the check be mailed: Street:
City:
Check memo (IE. Cardholder name, Card #, Client #) :
If you are requesting a paper check, please check here:
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signature
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