Treasury Offset Program Customer Feedback Form

Contact the Exchange concerning collections made under the Treasury Offset Program.

For assistance, please fill out the form below:

Last Name of Account Holder

First Name of Account Holder

Rank

Date of Birth (MM/DD/YY)

16-digit Account Number

*Social Security Number

* Disclosure of your social security number and other personal information is solicited by authority of Title 10, United States Code, Sections 3013 & 8013. This information is used to process your inquiry about Dishonored checks. Failure to provide this information may result in your inquiry not being answered.

Current Mailing Address:

Street / P.O. Box: Apt. #:

City:   State:   Zip Code:

Your installation/exchange:

Enter your comments in the space provided below :

Note: if you wish to make a change of address use the forms at the bottom of the page.

Tell us how to get in touch with you:

*E-Mail

Home Telephone: () -

Work Telephone: () -

Fax Number: ( ) -

*Please enter only one e-mail address. Please verify that your e-mail and telephone numbers are correct.

For Address changes ONLY:

Old Address:

Name:

Address:

City:   State:   Zip Code:

New Address:

Name

Address

City:   State:   Zip Code:

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