Model Form for Short Form Disclosures for Payroll Card Accounts

You do not have to accept this payroll card.
Ask your employer about other ways to receive your wages.

Type of fee Amount
ATM balance inquiry (in-network or out-of-network) $0 or $1.95*
Customer service (automated or live agent) $0 or $1.95 per call
Inactivity $0
We charge 4 other types of fees. Here are some of them:
Type of fee Amount
[Additional fee type] $1.00*
[Additional fee type] $3.00

* This fee can be lower depending on how and where this card is used.
[See [location] for free ways to access your funds and balance information.]

No overdraft/credit feature.
Your funds are eligible for FDIC insurance.

For general information about prepaid accounts, visit
Find details and conditions for all fees and services in the cardholder agreement.