Model Form for Short Form Disclosures for Prepaid Accounts, Example 2

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] $1.00*
[Additional fee type] $3.00

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

No overdraft/credit feature.
Not FDIC insured. Register your card for 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