Prepaid Interview Testing Phase 2

A-10(a) – Model Form for Short Form Disclosures for Government Benefit Accounts (§ 1005.15(c)(2) and § 1005.18(b)(3)(iii)(A))

You do not have to get your payments on this prepaid card.
Ask about other ways to get your payments.

Monthly fee

$0

Per purchase

$0 with sig.
$0 with PIN

ATM withdrawal

Cash reload

$0 in-network
N/A
$2.00 out-of-network

No overdraft or credit-related fees.
ATM balance inquiry (in-network or out-of-network)

$0 or $1.00*

Customer service

$1.50 per call

Inactivity (no transactions for 3 months)

$4.50 per month

[Incidence-based fee]

$2.95

[Incidence-based fee]

$3.95

[Incidence-based fee]

$1.00

*Fees can be lower depending on how and where this card is used.
We charge 6 other fees not listed here.
Register your card with XYZ Prepaid Company to protect your money.
For more information about prepaid cards, visit cfpb.gov/prepaids.

A-10(b) – Model Form for Short Form Disclosures for Payroll Card Accounts (§ 1005.18(b)(2)(i)(A) and § 1005.18(b)(3)(iii)(A))

You do not have to accept this payroll card.
Ask your employer about other ways to get your wages.

Monthly fee

$0

Per purchase

$0 with sig.
$0 with PIN

ATM withdrawal

Cash reload

$0 in-network
N/A
$2.00 out-of-network

No overdraft or credit-related fees.
ATM balance inquiry (in-network or out-of-network)

$0 or $1.00*

Customer service

$1.50 per call

Inactivity (no transactions for 3 months)

$4.50 per month

[Incidence-based fee]

$2.95

[Incidence-based fee]

$3.95

[Incidence-based fee]

$1.00

*Fees can be lower depending on how and where this card is used.
We charge 6 other fees not listed here.
Register your card with XYZ Prepaid Company to protect your money.
For more information about prepaid cards, visit cfpb.gov/prepaids.

A-10(c) – Model Form for Short Form Disclosures for Prepaid Accounts With Overdraft Services and Other Credit Features
(§ 1005.18(b)(2)(i)(B)(9) and § 1005.18(b)(3)(iii)(A))

Monthly fee
$4.95*

Per purchase

$0 with sig.
$0 with PIN

ATM withdrawal

Cash reload

$0 in-network
$2.00*
$2.00 out-of-network

This card may charge credit-related fees.
ATM balance inquiry (in-network or out-of-network)

$0 or $1.00

Customer service

$1.50 per call

Inactivity (no transactions for 3 months)

$4.50 per month

[Incidence-based fee]

$2.95

[Incidence-based fee]

$3.95

[Incidence-based fee]

$1.00

*Fees can be lower depending on how and where this card is used.
We charge 6 other fees not listed here.
Find details and conditions for all fees and services inside the package
or call 800-234-5678 or visit bit.ly/XYZprepaids.
Register your card with XYZ Prepaid Company to protect your money.
This card does not provide [FDIC][NCUSIF] insurance.
For more information about prepaid cards, visit cfpb.gov/prepaids.

A-10(d) – Model Form for Short Form Disclosures for Prepaid Accounts Without Overdraft Services and Other Credit Features
(§ 1005.18(b)(2)(i)(B)(9) and § 1005.18(b)(3)(iii)(A))

Monthly fee
$4.95*

Per purchase

$0 with sig.
$0 with PIN

ATM withdrawal

Cash reload

$0 in-network
$2.00*
$2.00 out-of-network

No overdraft or credit-related fees.
ATM balance inquiry (in-network or out-of-network)

$0 or $1.00

Customer service

$1.50 per call

Inactivity (no transactions for 3 months)

$4.50 per month

[Incidence-based fee]

$2.95

[Incidence-based fee]

$3.95

[Incidence-based fee]

$1.00

*Fees can be lower depending on how and where this card is used.
We charge 6 other fees not listed here.
Find details and conditions for all fees and services inside the package
or call 800-234-5678 or visit bit.ly/XYZprepaids.
Register your card with XYZ Prepaid Company to protect your money.
This card does not provide [FDIC][NCUSIF] insurance.
For more information about prepaid cards, visit cfpb.gov/prepaids.

A-10(e) – Sample Form for Long Form Disclosures for Prepaid Accounts (§ 1005.18(b)(3)(iii)(A))
Fee description

Amount

Details

Get started
Card purchase fee

$3.95

Monthly usage
Monthly fee

$4.95

Charge waived with direct deposit or in any billing cycle when you load at least $1,000 or
have at least 30 qualifying purchases posted to your account.

Add money
Direct deposit

$0

Cash reload

$2.00

Additional reload network fees may apply.

Spend money within the U.S.
Per purchase with PIN

$0

Per purchase with signature

$0

Online bill pay service by check

$2.00

Charge for having us send a check to pay a bill on your behalf. Charge waived for paying
a bill online.

ATM withdrawal, in-network

$0

“In Network” refers to the XYZMoney ATM network. Locations can be found at
xyzprepaid.com or xyzmoney.com. You will not be charged a fee by XYZ Prepaid Card or
the ATM operator.

ATM withdrawal, out-of-network

$2.00

“Out of Network” refers to all the ATMs outside of the XYZMoney ATM network. You may
also be charged a fee by the ATM operator even if you do not complete a transaction.

Bank teller cash withdrawal

$1.25

Get cash

Information
Customer service

$1.50

per call

ATM balance inquiry, in-network

$0

“In Network” refers to the XYZMoney ATM network. Locations can be found at
xyzprepaid.com or xyzmoney.com.

ATM balance inquiry, out-of-network

$1.00

“Out of Network” refers to all the ATMs outside of the XYZMoney ATM network. You may
also be charged a fee by the ATM operator even if you do not complete a transaction.

Replacement card

$4.00

Card will arrive within 5-7 business days.

Expedited replacement card service

$25.00

Card will arrive within 2 business days.

Inactivity

$4.50

You will be charged this fee each month after you have not completed a transaction using
your prepaid account for 3 months.

Each international transaction

3.0%

of total transaction amount

International ATM balance inquiry

$5.00

This is our fee. You may also be charged a fee by the ATM operator.

Other

Spend money outside the U.S.

This card does not provide [FDIC][NCUSIF] insurance.
Contact XYZ Prepaid Company by calling 1-800-555-5555, by mail at 555 Street Name, Anytown, NY, or visit xyzprepaid.com.
For more info about prepaid cards, visit consumerfinance.gov/prepaids. If you have a complaint about prepaid cards, call 1-855-411-2372 or visit
consumerfinance.gov/complaint.

A-10(f) – Model Form for Short Form Disclosures for Prepaid Accounts With Multiple Service Plans (§ 1005.18(b)(3)(iii)(B)(1 ))

Pay-asyou-go plan

Monthly
plan

Annual
plan

Plan fee

$0.00

$4.95 per mo.

$49.95 per yr.

Per purchase

$2.00*

$0

$0

This card may charge credit-related fees.

Applies to all plans

ATM withdrawal

$1.95*

Cash reload

$0

ATM balance inquiry

$1.00*

Customer service

$1.00 per call

Inactivity (no transactions for 3 months)

$1.95 per month

[Incidence-based fee]

$2.95

[Incidence-based fee]

$3.95

*Fees can be lower depending on how and where this card is used.
We charge 6 other fees not listed here.
Find details and conditions for all fees and services inside the package
or call 800-234-5678 or visit bit.ly/XYZprepaids.
Register your card with XYZ Prepaid Company to protect your money.
This card does not provide [FDIC][NCUSIF] insurance.
For more information about prepaid cards, visit cfpb.gov/prepaids.

A-10(g) – Sample Form for Long Form Disclosures for Prepaid Accounts With Multiple Service Plans (§ 1005.18(b)(3)(iii)(B)(2 ))

Fee description

Pay-asyou-go plan

Monthly
plan

Annual
plan

Details

Charge waived with direct deposit or in any
billing cycle when you load at least $1,000 or
have at least 30 qualifying purchases posted to
your account.

Monthly usage

Plan fee

$0

$4.95

$49.95

Per purchase with PIN

$1.00

$0

$0

Per purchase with signature

$2.00

$0

$0

Customer service

$1.00

$0

$0

per call

ATM balance inquiry, in-network

$0

$0

$0

“In Network” refers to the ABCMoney ATM network. Locations can be found at xyzprepaid.com
or abcmoney.com.

$0

“Out of Network” refers to all the ATMs outside of
the XYZ ATM network. You may also be charged
a fee by the ATM owner even if you do not complete a transaction.

Spend money within the U.S.

Information

ATM balance inquiry, out-of-network

$1.00

$0

Fee description

All plans

Details

Get started
Card purchase fee

$3.95

Add money
Direct deposit

$0

Cash reload

$2.00

Additional reload network fees may apply.

Spend money within the U.S.
Card to card transfer

$0.75

Online bill pay service by check

$2.00

Charge for having us send a check to pay a bill on your behalf. Charge waived for
paying a bill online.

Get cash
ATM withdrawal, in-network

$0

ATM withdrawal, out-of-network

$1.95

Bank teller cash withdrawal

$1.25

Other
Inactivity (no transactions for 3 months)

$1.95

You will be charged this fee each month after you have not completed a transaction
using your prepaid account for 3 months.

This card does not provide [FDIC][NCUSIF] insurance.
Contact XYZ Prepaid Company by calling 1-800-555-5555, by mail at 555 Street Name, Anytown, NY, or visit xyzprepaid.com.
For more info about prepaid cards, visit consumerfinance.gov/prepaids. If you have a complaint about prepaid cards, call 1-855-411-2372 or visit
consumerfinance.gov/complaint.