outstanding balance repayment form - microsoft...outstanding balance repayment form instructions...
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![Page 1: Outstanding Balance Repayment Form - Microsoft...Outstanding Balance Repayment Form Instructions Please fill out your details below and mail this form, along with a check for your](https://reader030.vdocuments.us/reader030/viewer/2022041122/5f37a77b7cdf370c991738ec/html5/thumbnails/1.jpg)
Outstanding Balance Repayment Form
Instructions
Please fill out your details below and mail this form, along with a check for your total balance due, to:
Alight Smart-Choice Accounts P.O. Box 660114
Dallas, TX 75266-0114
Your Details
Employer Name:
First Name:
Last Name:
Mailing Address:
Employee ID or Last 4 of SSN:
Please note: It may take up to 5 business days to process your repayment once it is received.