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A DIVISION OF GeSO CREDIT UNION
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__________________________________________________________________________________________
__________________________________________________________________________________________
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Online Bill Payer Research Request
Name ________________________________________ Member number ____________________
Daytime phone (______) ______-_______ E-mail address ________________@________________
Payee information
Payee name _____________________________________ Payment due date
/
/
Please identify the payee (choose one)
Telecommunications Company Insurance Utilities Loan
Please enter the area code and phone Auto Electric Auto Auto Lease
number next to the applicable service.
Home Gas Equity Mortgage
Cellular
(_____)_____-_____
Other Water Personal Credit Card
Residential
(_____)_____-_____
Insurance policyholder’s name
Student Other (describe below)
Long distance
(_____)_____-_____
_________________________________
_________________________________
_________________________________
Problem to be resolved (choose one)
Please describe any problem not listed below in “Additional comments.”
Payment hasn’t been received by payee. Please research.
Photocopy request (proof of payment)
Payment hasn’t been received. Please stop payment
Please indicate how you would like to receive the proof of payment.
on the check and refund my account (check payments only)
.
Fax to (_____)______-______ ATTN: ________________
Payment processed twice.
E-mail to ________________@______________________
Late fees incurred with payee. Amount of fee $_______
Mail to _________________________________________
Payment due date _____/_____/_____
_________________________________________
Additional comments _______________________________________________________________________
Fax completed form to Credit Services: (206) 676-3649, or
Mail completed form to Credit Services: P.O. Box 576, Seattle, WA 98111-0576
Questions? Call (206) 628-6055 or 1-888-628-4010, ext. 6055
