Model Form E

ABC Prepaid Card
The following is a complete list of fees you may be charged.

Initial purchase of card (online/in-store)
Set-Up &
Monthly fee
Maintenance
Inactivity (if no transactions** for 3 months)
Direct deposit
Reload pack
Add &
Withdraw Online transfer
Money
Transfer to other ABC Prepaid Card accounts
ATM withdrawal (in-network/out-of-network/international)
Purchase (with signature/with PIN)
Make
Purchases Online bill pay
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
Activation fee
Teller withdrawal
Cash back with purchase
Foreign transaction fee
Bill pay using paper check or money order
Paper monthly statement
Other
Electronic monthly statement
Fees
Replacement or additional card
ATM decline
Purchase decline
Refund check
Stop payment
Low balance fee (if balance is less than $25)
Overdraft
No overdraft fees
Program

$0/$5.95
$5.95*
$4.95 per month
$0
$3.95***
$2.00
$1.00
$0/$2.50***/$5.00***
$1.00/$2.00
$2.00 per trans.
$0/$2.50***/$5.00***
$0
$2.50 per call
$0
$1.00
$2.50
$2.00
3% of transaction
$2.95
$2.50
$1.00
$9.95
$1.95
$1.95
$2.50
$4.95
$2.00
$0

*$0 if at least $1,000 loaded onto card or 30 purchases made in that month. Your first monthly charge will be assessed 30 days
from when you register your card or 60 days after card purchase, whichever comes first.
**“No transactions” is defined as no purchases, no cash withdrawals, no load transactions or no balance inquiry fees for 90 days.
***Third party fees may also apply.
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, 855729-2372 (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 E – Online