Courtesy Pay Opt-In and Opt-Out Authorization Michigan Columbus Federal Credit Union offers Courtesy Pay, a discretionary overdraft service. Federal Regulation E requires your permission before we can charge a fee for paying overdrafts on everyday debit card transactions using your debit card. * Required Fields Member First Name: Member Last Name: Member Account Number: Contact Number: Email Address: Please Select One: OPT IN - I authorize MCFCU to pay overdrafts on everyday debit card transactions OPT OUT - I do not authorize MCFCU to pay overdrafts on everyday debit card transactions Fee Disclosure If you opt in to Courtesy Pay for everyday debit card transactions, you may be charged a Courtesy Pay (overdraft) fee of $30.00 per item each time we pay an overdraft. There is no limit on the total fees we may charge you for overdrawing your account unless otherwise disclosed in the account agreement. We may authorize and pay overdrafts for checks and other transactions made using your checking account number. We may authorize and pay overdrafts for automatic bill payments. We will not authorize and pay overdrafts for everyday debit card transactions unless you ask us to. E-Sign and Agreement Disclosure Please read this Disclosure and Consent to the Use of Electronic Signatures and Records ("Disclosure") carefully, it contains important information. In this disclosure, "we", "us" and "our" are used to refer to the financial institution providing the service or account you are applying for, and its current and future affiliates. "You" and "your" refer to the person giving this consent. In order to complete this transaction electronically, we need your consent to use electronic records and signatures. We will provide you with all the necessary equipment, as well as any assistance you may require completing this transaction in our branch or office. If you do not consent to the use of electronic records and signatures, you will be unable to proceed electronically and may be unable to complete the transaction. Additionally, we are required by law to provide you with certain information in this transaction "in writing" which means you have a right to receive that information on paper. However, with your consent, we may also provide this information to you electronically. By checking the box, you are consenting to use electronic records and signatures in connection with this transaction and that your electronic signature will be just as enforceable as signing the same document using a handwritten signature. I have read and accept the terms and conditions of the Esign agreement and Disclosure: Yes No Today's Date: Today's Date: Month Month... January February March April May June July August September October November December / Today's Date: Day Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Today's Date: Year Year... 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046 E-Signature - Please use your mouse to sign: