Dormant Customer Report Form
Use this form to identify and document dormant customer accounts in accordance with company policy.
Reporter Name
*
First Name
Last Name
Reporter Email Address
*
example@example.com
Customer Name
*
First Name
Last Name
Customer Account ID or Reference
*
Account Type
*
Please Select
Checking
Savings
Loan
Credit Line
Other
Date of Last Account Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Dormancy
*
Please Select
No recent transactions
Customer request
Returned mail
Unable to contact
Other
Actions Taken Prior to Reporting
Attempted contact (phone/email)
Sent reminder letter
Reviewed account history
Escalated to management
Other
Additional Notes or Comments
Submit Report
Should be Empty: