Form DD Form 2887 DD Form 2887 DoD Stored Value Card (SVC) Enrollment and Authorization

APPLICATION FOR DEPARTMENT OF DEFENSE (DoD) STORED VALUE CARD (SVC) PROGRAMS

OMB No.
OMB approval expires

The public reporting burden for this collection of information is estimated to average XX per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 1155 Defense Pentagon, Washington, DC
20301-1155 (XXXX-XXXX). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does
not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ADDRESS. SUBMIT COMPLETED FORMS AS DIRECTED BELOW.

PRIVACY ACT STATEMENT

AUTHORITY: Executive Order 9397; 31 CFR 210; and 31 U.S.C. 7701.
PRINCIPAL PURPOSE(S): To enroll individuals in DoD Stored Value Card (SVC) programs; to obtain authorization to initiate debit and credit entries to individual's accounts; and
to facilitate collection of any delinquent amounts.
ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. Section 552a(b) of the Privacy Act of 1974, as amended. It may be
disclosed outside of DoD to the U.S. Department of the Treasury, Fiscal and Financial Agents involved in providing DoD SVC services, and their contractors. In addition, other
Federal, State, or local government agencies that have identified a need to know may obtain this information for the purpose(s) identified in the DoD Blanket Routine Uses as
published in the Federal Register. Aggregate data about transactions captured both on and off the installation or ship, whether through the card's electronic purse or magnetic
strip, may be used to generate summary level reports.
DISCLOSURE: Disclosure is voluntary; however, failure to furnish the requested information may prevent you from participating in the DoD SVC programs. Your SSN is being
requested to verify your identity and to facilitate the collection of any amounts that may become due to the government as a result of your use of the SVC. If you do not provide
your SSN, we cannot process your application for an SVC.

DIRECTIONS: Submit completed form to Disbursing or Finance Office or other authorized person coordinating enrollment for DoD-approved SVC program. Provide bank or
credit union information if you wish to transfer funds from your bank or credit union account to your SVC account at an SVC kiosk or cashless ATM. For more information about
DoD SVC programs, please visit http://www.fms.treas.gov/eaglecash or http://www.fms.treas.gov/navycash.

1. STORED VALUE CARD (SVC) PROGRAM APPLYING FOR (X as applicable)
EAGLECASH

NAVY CASH/MARINE CASH

OTHER (Specify)

SECTION I - APPLICANT PERSONAL INFORMATION
2. RATE, RANK, TITLE
6. SSN

7. PAY GRADE

3. FIRST NAME

4. MIDDLE INITIAL

8. MILITARY BRANCH OR COMPANY NAME
(Contractors)

9. DATE OF BIRTH
(MMDD)

5. LAST NAME
10. MOTHER'S MAIDEN NAME OR KEYWORD
(Required for security purposes)
b. USMC ONLY
(1) MEU
(2) MLG

11.a. MILITARY DUTY ADDRESS (For Navy/Marine Cash include assigned Division, Unit, etc.) OR WORK ADDRESS (Contractors)

c. CITY
12.a. RESIDENCE/PERMANENT ADDRESS
b. CITY

13. WORK TELEPHONE NUMBER

d. STATE

e. ZIP CODE

f. COUNTRY

NEEDS DD 67
c. STATE

14. CELL TELEPHONE NUMBER

d. ZIP CODE

e. COUNTRY

15. E-MAIL ADDRESS

SECTION II - APPLICANT BANK OR CREDIT UNION INFORMATION
16.a. BANK OR CREDIT UNION NAME

17. ABA ROUTING NUMBER (9-digit number)

b. CITY

c. STATE

d. ZIP CODE

18. ACCOUNT NUMBER

19. ACCOUNT NAME (Your name as it appears on your account)

20. ACCOUNT TYPE (X one)
CHECKING

SAVINGS

SECTION III - STATEMENTS OF UNDERSTANDING
DEBT COLLECTION/WAIVER OF PRIOR DUE PROCESS: In consideration of receiving a DoD SVC, I hereby knowingly and voluntarily consent to the
immediate collection from my pay (military or civilian DoD pay), without prior notice or prior opportunity for a hearing or review, of any amounts that may
become due and owing as a result of my use of the SVC. This means the government may deduct amounts owed from my pay as authorized by 5 U.S.C.
5514, 37 U.S.C. 1007, and other applicable laws. If I am employed by a contractor or if I am no longer receiving military or civilian pay, and amounts remain
or become due and owing, I understand that the government will initiate debt collection procedures in accordance with the Federal Claims Collection
Standards (31 C.F.R. Parts 900-904) and Chapters 28-32, Volume 5, DoD 7000.14-R, DoD Financial Management Regulation.
EXPIRED, LOST, STOLEN, OR DAMAGED CARD: When my DoD SVC expires, any value remaining will be forwarded to my bank or credit union account
specified above. If the account has been closed or if any value remaining on the SVC cannot be forwarded to the account for any other reason, I understand
that the funds will be transferred to an account in the U.S. Treasury in accordance with 31 U.S.C. 1322 and that I retain the right to claim such funds. For
Navy Cash/Marine Cash only: If my DoD SVC is lost, stolen, or damaged, I may be charged a fee for a replacement card.
ADDITIONAL TERMS AND CONDITIONS: By using the DoD SVC, I agree to accept the terms and conditions for use of the SVC established by the issuer
of the card. This form may be imaged and kept on file electronically by the U.S. Department of the Treasury and/or its Financial or Fiscal Agent. The
electronic image shall be considered the legal equivalent of the original.
SECTION IV- AUTHORIZATION TO MAKE DoD SVC TRANSFERS ELECTRONICALLY TO AND FROM MY BANK OR CREDIT UNION ACCOUNT
I authorize the U.S. Treasury's Financial Agent to initiate debit and credit entries to my bank or credit union account at the financial institution specified above
in order to fulfill any requests I may make to transfer funds between my bank or credit union account and my SVC account.
21. SIGNATURE

22. DATE SIGNED (YYYYMMMDD)

SECTION V - FOR OFFICE USE ONLY
23. ISSUED BY (Disbursing/Finance Office Name/Location)

DD FORM 2887, 20080108 DRAFT

24. CARD NUMBER (Last 6 digits)

PREVIOUS EDITION IS OBSOLETE.

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