Note: Completing and submitting this form does not ensure your account will receive a credit. Each request will be reviewed and responded to within 45 days of receipt of an accurately completed submission. Requests lacking specificity may be delayed in receiving a response. Accounts are considered for one (1) lifetime courtesy late fee adjustment according to SBD Policy 1-7. By submitting this form you understand that if an adjustment is granted as a courtesy, the once per lifetime courtesy adjustment allowance will be exhausted.