[FIRM NAME]

DATE:

A/R ADJUSTMENT FORM

OFFICE:

INCREASE

CLIENT

INVOICE

(DECREASE)

EXPL.

BILLER

CLIENT NAME

NUMBER

NUMBER

AMOUNT

CODE

INITIALS

COMMENTS

0.00

EXPLANATION CODES:

Authorized by:_______________

1)  Correct payment application

2)  Overpayment-Refund

3)  Change invoice amount

4)  Cancel invoice

5)  Bad debt write-off

6)  Service charge write-off