Model Form D

ABC Prepaid Card
We may also charge other fees not listed here. For a full list of fees, terms, and conditions, visit
www.ABCPrepaid.com/fees or see the enclosed account agreement.
Initial purchase of card (online/in-store)
Set-Up & Monthly fee
Maintenance
Inactivity (if no transactions for 3 months)
Add &
Withdraw
Money

Direct deposit
Cash reload
ATM withdrawal (in-network/out-of-network/international)

$0/$5.95
$5.95*
$4.95 per month
$0
$3.95 or less**
$0/$2.50**/$5.00**

Purchase (with signature/with PIN)
Make
Purchases Online bill pay

$1.00/$2.00
$2.00 per trans.

ATM balance inquiry (in-network/out-of-network/international)
Get
Online or automated by phone
Account
Live agent customer service
Information
Access to electronic transaction history

$0/$2.50**/$5.00**
$0
$2.50 per call

Other
Fees

$0

Paper monthly statement

$2.50

Electronic monthly statement

$0.95

Replacement or additional card

$9.95

*$0 if at least $1,000 loaded onto card or 30 purchases made in that month. Your first monthly fee will be charged 30 days
from when you register your card or 60 days after card purchase, whichever comes first.
**Third party fees may also apply.
No overdraft fees.
Security of Funds: Your money is not protected against unauthorized transactions until you register this card. Funds
FDIC-insured upon registration. Your funds will not expire due to inactivity.
For More Information:
• For more information about prepaid cards, including comparison shopping resources, visit prepaids.consumerfinance.gov.
• For questions or complaints about ABC company, contact the Consumer Financial Protection Bureau at 855-411-2372,
855-729-2372 (TTY/TDD) or consumerfinance.gov.
In Case of Account Errors: You have a right to dispute errors. If you think there is an error, contact us at 888-123-4567 or
www.ABCPrepaid.com. You can also contact us for a written explanation of your rights.
To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial
institutions to obtain, verify, and record information that identifies each person who purchases a product like this card.

Form D – Summary, Hybrid Static/Dynamic