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

Type of fee Amount
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:
Type of fee Amount
[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
Find details and conditions for all fees and services inside the package, or call 800-234-5678 or visit