Model Form for Short Form Disclosures for Prepaid Accounts, Example 1

ATM balance inquiry (in-network or out-of-network) $0 or $0.50
Customer service (automated or live agent) $0 or $0.50* per call
Inactivity (after 12 months with no transactions) $1.00 per month
We charge 4 other types of fees. Here are some of them:
[Additional fee type] $0.50 or $1.00
[Additional fee type] $3.00

† No monthly fee with direct deposit or 30 transactions per month.

* This fee can be lower depending on how and where this card is used.

You may be offered overdraft/credit after 30 days. Fees would apply.
Register your card for FDIC insurance eligibility and other protections.

For general information about prepaid accounts, visit cfpb.gov/prepaid.
Find details and conditions for all fees and services inside the package, or call 800-234-5678 or visit xyz.com/prepaid.