Print and web templates for prepaid account disclosures under the CFPB's final prepaid rule

Print templates

Form Description
Model form A-10(a) Model Form for Short Form Disclosures for Government Benefit Accounts
(§1005.15(c) and §1005.18(b)(2), (3), (6), and (7))
Model form A-10(b) Model Form for Short Form Disclosures for Payroll Card Accounts
(§1005.18(b)(2), (3), (6), and (7))
Model form A-10(c) Model Form for Short Form Disclosures for Prepaid Accounts, Example 1
(§1005.18(b)(2), (3), (6), and (7))
Model form A-10(d) Model Form for Short Form Disclosures for Prepaid Accounts, Example 2
(§1005.18(b)(2), (3), (6), and (7))
Model form A-10(e) Model Form for Short Form Disclosures for Prepaid Accounts with Multiple Service Plans
(§1005.18(b)(2), (3), (6), and (7))
Sample form A-10(f) Sample Form for Long Form Disclosures for Prepaid Accounts
(§1005.18(b)(4), (6), and (7))
View the collected examples in a single PDF

Web templates

Form Description
Model form A-10(a)
Code | Preview
Model Form for Short Form Disclosures for Government Benefit Accounts
(§1005.15(c) and §1005.18(b)(2), (3), (6), and (7))
Model form A-10(b)
Code | Preview
Model Form for Short Form Disclosures for Payroll Card Accounts
(§1005.18(b)(2), (3), (6), and (7))
Model form A-10(c)
Code | Preview
Model Form for Short Form Disclosures for Prepaid Accounts, Example 1
(§1005.18(b)(2), (3), (6), and (7))
Model form A-10(d)
Code | Preview
Model Form for Short Form Disclosures for Prepaid Accounts, Example 2
(§1005.18(b)(2), (3), (6), and (7))
Model form A-10(e)
Code | Preview
Model Form for Short Form Disclosures for Prepaid Accounts with Multiple Service Plans
(§1005.18(b)(2), (3), (6), and (7))
Sample form A-10(f)
Code | Preview
Sample Form for Long Form Disclosures for Prepaid Accounts
(§1005.18(b)(4), (6), and (7))

Each disclosure’s HTML file links to the CSS found in web/static/css/style.css.