Payment Reporter

Merit Payment Reporter

You can use this new Merit Payment Reporter to securely report any insured payments.

* Indicates required field

Brokerage Name *

Merit Broker Code *

Agent Name *

Agent Email *

Customer Name *

First

Last

Customer Name (2) *

First

Last

Enterprise Name or O/A *

Merit Acct Number *

Amount Due *

Amount Received *

Further Information *

Secure Send

Please complete the form for multiple payment report and then email it to Merit at [email protected]

merit_payment_reporter_form.pdf
File Size:	75 kb
File Type:	pdf