Home - Forms - Check Services Forms

Check Services Forms

Use the links below to access the forms and agreements you will need to set up or use Federal Reserve Financial Services.

Service and Access Setup provides more details and guidance on the steps required to begin using a new service or to modify current services or access.

If you are unable to locate the form you seek, My FedDirectory^SM provides a comprehensive list of service and support contacts who can assist you.

Check 21-Enabled Services Agreements
Check Adjustment Services Forms
Cash Letter Forms
Vendor Profile Form
Additional Check Service Agreements
District Check Forms

Check 21-Enabled Services Agreements
FedForward Cull Service Agreement Completion of this form is required before a financial institution may send electronic items to a Federal Reserve Bank, receive electronic items from a Federal Reserve Bank, or send to a Reserve Bank physical items that are designated for processing under Appendix G of Federal Reserve Bank Operating Circular 3 (collectively, “Items”). The Federal Reserve Bank uses this form to obtain information that is needed to successfully complete “Check 21” product enrollment and set-up processes.	Form (PDF)
Check 21 Services Agreement and Set Up Form (v 5.7) Completion of this form is required before a financial institution may send electronic items to a Federal Reserve Bank, receive electronic items from a Federal Reserve Bank, or send to a Reserve Bank physical items that are designated for processing under Appendix G of Federal Reserve Bank Operating Circular 3 (collectively, “Items”). The Federal Reserve Bank uses this form to obtain information that is needed to successfully complete “Check 21” product enrollment and set-up processes.	Form (PDF)
Check 21 Agency Agreement (v 2.0) This agreement appoints an agent for accessing Federal Reserve Bank Check Collection and Return Services.	Form (PDF)
Electronic Check Presentment and Image Information Service This Agreement sets forth the terms of our Electronic Check Presentment and Image Information Service.	Form (PDF)
Electronic Return Notification Service for Non-Imageable Returned Checks This Agreement sets forth the terms of our Electronic Return Notification Service.	Form (PDF)

Top of Page

Check Adjustment Services The following electronic forms are available to support processing of all check adjustment requests. For more information on the required forms, visit the Check Adjustments Quick Reference Guide
Check Adjustment Request Form	Form (PDF)
Check 21 Warranty/Indemnity Claim Form	Form (PDF)
Claim of Late Return	Form (PDF)
Claim of Damage Due to an Underencoding	Form (PDF)
Document-to-Follow (DTF) Fax Cover Sheet	Form (PDF)
Duplicate Check/Image Adjustment Certification Form	Form (PDF)
Expedited Recredit Claim Form	Form (PDF)
Paying Bank's Response to a Claim of Late Return	Form (PDF)

Top of Page

Cash Letter Forms Standardized cash letter forms are offered for your use when sending cash letters to your local Federal Reserve Bank. These forms will open in Microsoft Excel and include drop down lists with selections to help you fill out the form.
Canadian Check	Form (XLS) Instructions (Off-site Link)
Foreign Check	Form (XLS) Instructions (Off-site Link)
Check 21 FedForward	Form (XLS) Instructions (Off-site Link)
EZ Clear (Savings Bonds) Your Financial Institution must be enrolled in the EZ Clear Program before ordering cash letter forms. Click here (Off-site Link) for details about the EZ Clear Program or to enroll.	Form (XLS) Instructions (Off-site Link)
Forward Item	Form (XLS) Instructions (Off-site Link)
Forward Not Our Item	Form (XLS) Instructions (Off-site Link)
Government Deposit	Form (XLS) Instructions (Off-site Link)
Image Only - Non Deposit	Form (XLS) Instructions (Off-site Link)
Large Dollar Return	Form (XLS) Instructions (Off-site Link)
Non-Imageable Forward Items Deposit	Form (XLS) Instructions (Off-site Link)
Non-Imageable Return Items Deposit	Form (XLS) Instructions (Off-site Link)
Postal Money Order	Form (XLS) Instructions (Off-site Link)
Return Item	Form (XLS) Instructions (Off-site Link)
Return Not Our Item	Form (XLS) Instructions (Off-site Link)

Top of Page

Vendor Profile Form
Vendor Profile Form Completion of the form allows the Federal Reserve Banks to notify vendors supporting our check services about announcements that affect software vendors.	Form (DOC)

Top of Page

Additional Check Service Agreements
Delivery Point- Physical Items Agreement	Form (PDF)
Delivery Point- Adjustment Advices Agreement	Form (PDF)
MICR, Truncation and Information Services Agreement	Form (PDF)
FedImage Information Services Agreement	Form (PDF)
Same Day Settlement (SDS) Services Agreement	Form (PDF)
Explicit Float Availability Option Agreement	Form (PDF)
Return Item Re-Clearing Service Agreement	Form (PDF)
Service Discontinuation Notice	Form (PDF)
Canadian Check Processing Service Sign-Up Form Please wait 10 days from submission of this form to deposit Canadian items.	Form
Foreign Check Sign-Up Agreement Please wait 10 days to begin depositing your foreign items.	Form (Off-site Link)

Top of Page

District Check Forms
1st District Federal Reserve Bank of Boston	Return Item Re-Clearing Service Agreement (PDF) MICR Contingency Service For Payor Banks Agreement Form (PDF) Bank's and Service Party's Request for Delivery and Presentment of Cash Letters or Return Letters Schedule A: Presentment Point and Other Bank Services Agreement (PDF) Same Day Settlement Service (PDF) Electronic Check Presentment Agreement Electronic Check Presentment Third Party Agreement
2nd District Federal Reserve Bank of New York	Manhattan Transit Point Agreement (PDF) Intercept Agreement for EROC zone customers (DOC) Intercept Agreement (DOC) Payor Bank Services Authorization Form for Utica Zone Customers (PDF) FRB Philadelphia Payor Bank Services Authorization Form (PDF) FRB Philadelphia Forms/Supplies Order Form for EROC zone customers (Off-site Link)
3rd District Federal Reserve Bank of Philadelphia	Check Collection Service Request Form. (PDF) Order Boxes and Batch Ticket (Off-site Link) Check Intercept Form (475) (PDF) New Check Depositor Form (PDF) Return Item Delivery Authorization (6) (PDF)
5th District Federal Reserve Bank of Richmond	Letter of Intent to Deposit (PDF) Presentment of Cash Letter/Return Letter Form (PDF) Foreign Check Agreement Forms (Off-site Link) Agreement for Delivery of Return Cash Letters (PDF)
6th District Federal Reserve Bank of Atlanta	Check Supply Orders (XLS)
11th District Federal Reserve Bank of Dallas	Request for Supplies (PDF) Duplicate Substitute Check/Image Adjustment Certification (PDF)
12th District Federal Reserve Bank of San Francisco	Treasury Cash Letter Recap (PDF) Treasury Cash Letter Recap (XLS) National Fine Sort Cash Letter Recap (PDF) San Francisco (PDF) Los Angeles (PDF) Portland (PDF) Salt Lake City (PDF) Seattle (PDF) National Fine Sort Cash Letter Recap (Excel) San Francisco (XLS) Los Angeles (XLS) Portland (XLS) Salt Lake City (XLS) Seattle (XLS)

Top of Page