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Account Agreement and Disclosures

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Credit Card Agreement and Disclosure Statement

This Agreement and Disclosure sets forth the terms of , (“NBI”), Credit Card Agreement and Disclosure.

It contains various disclosures and information required by law. Please read it carefully.

The NBI Credit Card Agreement and Disclosure Statement (hereinafter referred to as Agreement) covers your Classic and Gold Credit Card account (hereinafter referred to as Account) with NBI.

For purposes of this Agreement, the term credit card or card means a card, plate, coupon book, Loan Advance Draft, or other single credit device issued pursuant to this Agreement that may be used from time to time to obtain credit or services pursuant to this Agreement.

In this disclosure, the words you, your and yours refer to the account holder and each and all of those who apply for and/or use any of NBI’s Credit Card Accounts.

The word “ATM” means Automated Teller Machine. The word “EFT” means any Electronic Transfer of Funds other than by check or other paper instrument that is initiated through an electronic terminal, telephone, computer, magnetic tape or other communication device for the purpose of providing cash, debiting, crediting, transferring or inquiring on an account. The word “PIN” means Personal Identification Number.

Card Agreement and Disclosure

Use of the Loan Advance Draft is a cash advance against the Account.

If you have a joint account (accounts with more than one person obligated or authorized under the Agreement), each account holder has the right to use the account subject to the credit limit and other terms and conditions as described below. Each account holder is bound by these terms and conditions, and each of you individually will be liable for all fees and charges, even if only one of you uses the account.

Whenever used, herein, the singular includes the plural. If you authorize someone else to use your Credit Card or PIN you are responsible for all transactions which that person initiates at any time, even if the amount of the transaction exceeds what you authorize.

Credit Card Account Services: These services are available through your Account, up to the amount of your credit limit.

Purchases: You can use your Account to purchase goods or services where Credit Cards or Loan Advance Drafts are accepted.

Cash Advances: You can get a Cash Advance (loan) in person at NBI. You can also get a Cash Advance (loan) from your Account by using an ATM which is designated as Accepting Cards, by negotiating a Loan Advance Draft or by presenting your Credit Card at a financial institution that accepts Credit Cards.

You agree to the following terms and conditions and any amendments thereto.

A. MAXIMUM CREDIT LIMIT: You have applied to NBI for a “Credit Card” Personal Line of Credit Account. The loan which NBI may extend to you under this account shall at no time exceed the assigned credit limit, hereafter referred to as the Maximum Credit Limit.

B. LOANS COVERED: There are two types of credit available to you under this Agreement. You may utilize the Credit Card to charge purchases of goods and services at businesses where Credit Cards are accepted. Additionally, you may utilize the credit extended herein to receive cash advances from NBI or other institutions honoring the Credit Card.

LOAN ADVANCE DRAFTS: You may also access your credit line by utilizing the Loan Advance Drafts that may be provided to you.

1. NBI will honor and pay Loan Advance Drafts up to your credit limit as long as they are drawn on forms authorized by NBI and presented before the expiration date on the draft.

2. You may request a stop payment on any Loan Advance Draft payable against your account but it must be in writing.

3. If a Credit Card is reported lost or stolen, the loan advance drafts are null and void.

4. You agree to hold NBI harmless and to indemnify it from any liability incurred due to a delay or misrouting of the Loan Advance Draft.

5. For the purpose of calculating finance charges, Loan Advance Drafts are the same as Cash Advances.

6. NBI may recognize the signature of anyone who signed the credit application for the account as authorized to transact any business on this account.

7. Loan Advance Drafts may not be used to pay any amount you owe under this Agreement or under any other credit agreement or account you hold with NBI.

C. REQUEST FOR A LOAN: You agree that each use of the Credit Card constitutes a loan in the amount of the item. You agree not to exceed the approved Maximum Credit Limit under this Agreement.

D. CREDIT LIMITS: You agree not to exceed the Maximum Credit Limit and understand that NBI is not required to extend credit in excess of your Credit Limit or after the termination of this account.

E. FOREIGN TRANSACTIONS AND CHARGES: To the extent that you have used the Credit Card to purchase goods or services, or obtain cash in another country, the statement may reflect the conversion into U.S. dollars.

F. CLASSIC FINANCE CHARGES: The DAILY PERIODIC RATE used in calculating the FINANCE CHARGE is .0408219% which corresponds to a current ANNUAL PERCENTAGE RATE of 14.9% for Classic purchases and advances.

G. GOLD FINANCE CHARGES: FINANCE CHARGES on Gold transactions are computed using a variable rate of interest.

H. CALCULATION OF AVERAGE DAILY BALANCE: We calculate the Average Daily Balance as follows: the Average Daily Balance for the account, for the billing cycle, is the average of the ending balance for each day of the billing cycle.

I. ANNUAL FEE: [] An annual fee of $24 will be assessed during the same “anniversary month” each year.

J. PAYMENT: NBI will send to you, at monthly intervals determined by NBI, a statement reflecting all Card and related transactions for the prior monthly period.

K. RETURNS AND ADJUSTMENTS: Credit balances over 180 days old will be transferred to your .

L. PAYMENT DUE DATE: You will be notified on a Periodic Statement by NBI of payment due dates which will be effective upon use of this account.

M. LIABILITY FOR UNAUTHORIZED USE: Tell us at once if your Credit Card or PIN is lost or stolen or if you suspect any unauthorized use of your Credit Card or PIN.

You will not be liable for unauthorized use that occurs after you notify us in writing at P.O. Box , , or by phone at of the loss, theft, or possible unauthorized use of your Card.

N. LOST OR STOLEN CARD OR PIN: If you believe your Card and/or PIN has been lost or stolen, call us immediately at or write to NBI, at P.O. Box , .

YOUR BILLING RIGHTS

– KEEP THIS NOTICE FOR FUTURE USE –

This notice contains important information about your rights and your responsibilities under the Fair Credit Billing Act.

IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR STATEMENT

Telephone us at or write us at NBI, P.O. Box , , as soon as you think your statement is wrong or if you need more information about a transaction listed on the statement or transaction receipt.

If you have authorized us to pay your Credit Card Account automatically from your , checking account, or through payroll deduction, you can stop the payment on any amount you think is wrong.

YOUR RIGHTS AND OUR RESPONSIBILITIES AFTER WE RECEIVE YOUR WRITTEN NOTICE

If we find that we made a mistake on your statement, you will not have to pay any finance charges related to any questioned amount. If we didn’t make a mistake, you may have to pay finance charges.

IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC FUND TRANSFERS

Telephone us at or write us at NBI, P.O. Box , , as soon as you think your statement is wrong.

1. Tell us your name and account number.

2. Describe the error or the transfer you are unsure about.

3. Tell us the dollar amount of the suspected error.

UNAUTHORIZED TRANSACTIONS-PROVISIONAL CREDIT:

If you notify us of unauthorized transactions we will provide a provisional credit to your account within (5) business days of the notification.

ADDITIONAL FEES AND TERMS

OWNERSHIP OF CARD: The Credit Card is the property of NBI and you agree to surrender the Card to NBI upon demand.

You may designate authorized users to have access to your account and be issued a card on your account.

PREAUTHORIZED CHARGES: If you default, if the card is lost or stolen or we change your account or account number for any reason, we may suspend automatic charges on that account to third party vendors for insurance premiums or other goods or services.

CLOSING YOUR ACCOUNT: You may close your account at any time by notifying us in writing. However, you remain responsible to pay the total balance according to the terms of this Agreement.

REFUSAL OF THE CARD: We are not responsible if a transaction on your account is not approved, either by us or a third party, even if you have sufficient credit available.

ATM TRANSACTION LIMITATIONS: ATM transactions are limited to five (5) per day with a maximum cash withdrawal of $500 per day or your available credit limit, whichever is smaller.

PERSONAL IDENTIFICATION NUMBER: We will issue a Personal Identification Number (PIN) to you. This PIN will allow you to make cash withdrawals at ATMs.

RENEWAL OF CARD: Upon expiration of your Card, if your account is active and in good standing, we may issue you a renewal Card.

OVERDRAFTS: We may transfer funds from your regular and account(s), Money Market, and/or your or Line of Credit to pay overdrafts to your checking account.

CROSS ACCOUNTS: By requesting overdraft protection through funds transfers from a different NBI Account, a cross account relationship must be set up.

ILLEGAL TRANSACTIONS: You are prohibited from using your Card or your card number for illegal transactions including, but not limited to internet gambling.

DEFAULT: You will be in default if you fail to make any Minimum Payment within 25 days after the end of the Statement Period.

CROSS DEFAULT: Any breach or default of the terms and conditions of this Agreement for the Card Account shall also be deemed to be a default of any and all other loans, line of credit accounts and credit card agreements you now have with NBI.

TERMINATION OF CREDIT AND ACCELERATION OF PAYMENT:

You understand that future advances under this Agreement may be terminated under any of the following conditions:

1. In the event of default;

2. Upon failure of you to satisfy the terms of this Agreement;

3. Upon your failure to make any loan payment when due on any loan with NBI;

4. If you have made or do make any false or misleading statements;

5. If any attachment, execution or other legal process issued against any of your property;

6. Upon adverse re-evaluation of your credit worthiness;

7. You fail to provide the NBI with a current credit application when requested;

8. At the option of NBI or you with good cause.

COLLECTIONS: You agree that NBI shall be entitled to recover any money owed by you as a result of your use of the Card.

RESPONSIBILITY OF BORROWER/CARDHOLDER: You are required and do hereby agree to report to NBI any change in your NAME, ADDRESS or EMPLOYMENT.

PERSONAL FINANCIAL INFORMATION: You agree to complete a new application at any time we request, and you understand that we reserve the right to re-examine and re-evaluate your financial condition at any time.

POSTAL SERVICE: NBI assumes no responsibility for the mail. Payments will be credited to the account on the date RECEIVED.

AMENDMENTS: NBI may amend this Agreement, from time to time, upon proper advance notice to you.

LIABILITY OF ALL PERSONS SIGNING: Each borrower acknowledges that he/she shall be individually and jointly liable for the payment of all sums owing under the terms and provisions hereof.

COPY RECEIVED: By using your Credit Card, you acknowledge receipt of a copy of this Disclosure and Agreement.

APPLICABLE LAW: This Agreement and Disclosure Statement shall be construed and governed in accordance with the laws of the State of .

SEVERABILITY: If any part of this Agreement and Disclosure Statement should be held to be unenforceable, the remaining provisions shall remain in full force and effect.

OTHER CHARGES: Other charges which may be added to your account include:

LATE CHARGE: A late charge of $10 will be assessed to your account if your payment is not received within 10 days of the payment due date specified on your monthly statement.

OVER-LIMIT CHARGE: If you make a transaction with your Credit Card which results in your balance being over the credit limit, an over-limit charge of $10 may be assessed to your account.

FEE FOR TRANSFER FROM (name of type of account): Any funds transferred from your Regular Share Account to cover a check, ACH, Debit or transaction will result in a $2 fee.

REPLACEMENT CARDS: A fee of $5 will be assessed to your account whenever we furnish you with a new card to replace one which you lost or destroyed.

COPIES OF TRANSACTION SLIPS: We will charge your account $12 for each copy of a sales, cash advance or transaction slip we furnish to you in response to your request.

DUPLICATE STATEMENTS: We will charge your account $.50 for each duplicate copy of your monthly statement we furnish to you in response to your request.

RESEARCH CHARGES: We will charge your account $10 per hour for research we perform in response to an inquiry from you relative to your account.

CARD RECOVERY CHARGE: If we are required to pay a reward for the recovery of your lost, stolen or revoked card, we may apply such charges to your account.

SAFETY TIPS FOR USING YOUR CREDIT CARD

Your Credit Card provides you quick, convenient access to your Credit Line. We encourage you to be careful when using your Card. Here are some valuable tips:

 Memorize your PIN. Do not write it on your Card or have it written down on anything in your wallet.

 Keep your PIN a secret. Do not reveal your PIN to anyone.

 Keep your Credit Card in a safe place. Protect it. If it is lost or stolen, notify NBI immediately.

 Be aware of your surroundings. If someone looks suspicious or if the ATM is not well lit, choose another ATM in a safer location.

 Consider having another person accompany you to the ATM.

 When using an ATM, shield your actions so that people nearby can’t see you enter your PIN or perform your transaction.

 Put your money and receipt away before leaving the ATM.

 Never give information about your Credit Card or account to strangers.

 Don’t fall for “con” games. Use caution when asked to provide your Card number over the telephone or Internet.

 Report any suspicious requests to NBI as soon as possible.

 Sign the back of your card upon receipt.

NOTICE: IF YOU DO NOT AGREE TO THE TERMS OF THIS DISCLOSURE AND AGREEMENT, DESTROY YOUR CREDIT CARD IMMEDIATELY BY CUTTING IT IN HALF AND RETURN IT TO NBI, .

SPECIAL PROVISION FOR COLLATERAL

CROSS-COLLATERALIZATION: YOU UNDERSTAND AND AGREE THAT THE PERSONAL PROPERTY SECURITY FOR EACH LOAN YOU HAVE WITH THE NBI SHALL SECURE THIS CREDIT CARD ACCOUNT AND ANY AND ALL OTHER LOANS, LINE OF CREDIT ACCOUNTS AND CREDIT CARD ACCOUNTS YOU NOW HAVE WITH NBI OR OBTAIN IN THE FUTURE WITH THE NBI.

SECURITY INTEREST-PLEDGE OF DEPOSITS: YOU HEREBY PLEDGE ALL YOUR DEPOSITS IN NBI (INCLUDING SAVINGS AND CHECKING ACCOUNTS), WHICH YOU NOW HAVE OR HEREAFTER MAY HAVE IN NBI AS SECURITY FOR LOANS, INTEREST, LATE CHARGES, COST OR EXPENSES.

Borrower Signature: ______________________________

Printed Name:

Date:

Co-Borrower Signature: ______________________________

Printed Name:

Date:

Authorized User Request:

I request authorization for additional users on my account.

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What the Account Agreement and Disclosures cover

An Account Agreement and Disclosures is a combined contractual document that sets the terms governing an account relationship and provides the consumer or counterparty with required statutory or regulatory disclosures. It typically defines parties, services, fees, data use, privacy notices, cancellation terms, and any special disclosures required by federal or state law. This document creates enforceable rights and obligations once signed, and it may incorporate separate policies by reference. For regulated industries it often includes consumer consent language and acknowledgement of receipt of disclosures.

Why a single agreement with disclosures matters

Combining account terms and required disclosures clarifies obligations, reduces document churn, and makes it easier for signers to review all material terms in one place while meeting legal notice requirements under ESIGN and UETA.

Why a single agreement with disclosures matters

Typical users and signers for this document

The Account Agreement and Disclosures is used by organizations that open or manage customer accounts and must provide legally required notices with the contract.

  • Banks and credit unions opening consumer or business accounts, where regulatory disclosure obligations apply
  • Healthcare providers or clinics collecting administrative and consent information alongside account setup
  • Vendors and SaaS providers onboarding customers with fee schedules and privacy notices

Versions and supplemental disclosures vary by industry and jurisdiction; choose the form and delivery method that meet your regulatory and operational needs.

Core sections to include in a professional agreement

A complete Account Agreement and Disclosures should be organized so each section is easy to find, with clear headings and signature blocks for all parties.

Parties

Legal names and entity types for each party, state of organization, and contact details to establish who is bound by the terms.

Services

A concise description of the account services, permitted activities, limitations, and any service-level expectations tied to fees or access.

Fees & Payments

Detailed fee schedule, billing frequency, late payment consequences, and any third-party payment processor disclosures or convenience fees.

Privacy & Data Use

Disclosures describing data collected, purposes of processing, retention practices, and any consumer rights or opt-out mechanisms.

Consumer Disclosures

Statutory notices required by consumer finance, healthcare, or telecommunications law, consolidated with clear acknowledgement language.

Signatures & Dates

Execution blocks for all signers, printed names and titles, effective date, and witness or notary sections when required by law.

Essential data fields to capture

Legal Name: Full legal name
Contact Address: Street, city, state, ZIP
Tax ID / TIN: SSN or EIN as required
Email and Phone: Primary contact details
Effective Date: MM/DD/YYYY format
Authorized Signer: Name and title

Step-by-step: completing the agreement

Follow these steps in order to prepare, deliver, and finalize the Account Agreement and Disclosures with accurate records.

  • 01
    Prepare: Populate party details, terms, and required disclosures.
  • 02
    Review: Verify TINs, addresses, and disclosure language for compliance.
  • 03
    Deliver: Send to signers via secure electronic delivery or in person.
  • 04
    Record: Store executed copy and audit trail in a secure repository.

Configuring the online signing workflow

Set these workflow options before sending to ensure correct authentication, routing, and recordkeeping.

Field Configuration
Signature Type Email link | SMS code | RON if notarization required
Authentication Email + optional SMS or KBA
Routing Order Sequential or parallel signer order
Retention Encrypted cloud storage with audit trail

Delivering and processing electronically

Choose technology that supports required authentication and preserves an audit trail for legal enforceability.

  • File formats: PDF, DOCX, or fillable forms
  • Integrations: CRM and cloud storage connectors
  • Security: TLS transport and AES-256 storage

Ensure the chosen platform can produce an evidentiary audit trail and export signed records in a searchable, tamper-evident format.

Typical e-signing flow for the agreement

A reliable signing flow reduces signer friction and establishes a defensible record of consent and execution.

  • Upload Document: Sender uploads final document to the signing platform.
  • Place Fields: Add signature, date, and initial fields as needed.
  • Send to Signers: Dispatch by email or secure link with routing rules.
  • Audit Trail: System records timestamps, IP addresses, and actions.

Key timing and response expectations

Set and communicate times for review, execution, and retention so all parties know deadlines and compliance windows.

Review Period:

Allow a clear review window (e.g., 7–14 days) before execution.

Execution Deadline:

Specify an execution cutoff to avoid stale terms.

Consumer Withdrawal:

Provide a method and timeframe to withdraw consent if required.

Record Availability:

Deliver final executed copy promptly after signing.

Retention Start:

Retention begins on effective date or document creation.

Common preparation and execution mistakes to avoid

  • Using nonstandard disclosure language that fails to meet statutory consumer notice requirements.
  • Mismatching signer names or TINs between the agreement and supporting forms, which can trigger withholding or audit issues.
  • Failing to secure explicit ESIGN consumer consent for paperless delivery in consumer-facing accounts.
  • Omitting required signature witness or notary steps where state law or the document expressly demands them.

Principal legal and financial risks from errors

Incorrect TIN: Backup withholding 24% (IRC §3406)
Failed Disclosure: Regulatory penalties and rescission risk
Late Filing: Information return penalties (IRC §6721)
I-9 Errors: Civil fines per DHS rules
Improper Notarization: Record challenge or invalidation
Privacy Breach: HIPAA liability and corrective action

How an Account Agreement with disclosures compares to separate documents

Compare the combined form with separate disclosures and traditional contracts to choose the best approach for compliance and clarity.

Criteria Account Agreement Standalone Disclosure Standard Contract
Single document
Ease of delivery higher moderate moderate
Regulatory clarity high when updated depends varies
Signature footprint one execution block multiple acknowledgements standard signing

eSignature vendor pricing and capability snapshot

Cost and feature differences affect workflows for Account Agreement and Disclosures; choose a vendor that meets authentication, audit trail, and retention needs.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial, no credit card Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes (Business Premium) Available Available Available Varies
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No envelope cap 100 envelopes/user/year Varies Varies Varies

Real-world examples of combined agreements

These anonymized excerpts show how organizations use a single agreement to capture terms and required notices while preserving a clear audit record.

Optica Ventures

Optica consolidated account terms and disclosures into one document to reduce signer confusion.

  • It folded fee schedules and privacy notice into a single acknowledgment.
  • The combined approach streamlined onboarding and produced a single, time-stamped record that simplified audits and customer support workflows.

Fertility Centers of Illinois

The center included consent and financial policies in its account agreement to ensure patients acknowledged both.

  • Signers completed a single electronic session covering consent and billing terms.
  • This eliminated separate paper forms and created one secure, auditable file for each patient account.

Who is authorized to sign on behalf of an organization

CEO

An officer such as the CEO or President commonly has express authority to bind the organization. Confirm that the person signing has board or charter authority and document their title and capacity in the signature block.

Authorized Agent

Controllers or designated agents may sign under a written delegation of authority. Attach or reference a corporate resolution or power of attorney when signing authority is delegated.

Key processing milestones from preparation through storage

Track these sequential stages to ensure timely completion, dispute defensibility, and compliant retention.

01

Agreement Preparation

Draft and incorporate required disclosures before sending.

02

Delivery for Signature

Send with clear instructions and authentication controls.

03

Signer Execution

Capture signatures, timestamps, and any notarization.

04

Final Storage

Store executed copy with audit trail and backup.

Frequently asked questions and practical answers

Answers to common legal, technical, and process questions when preparing and delivering an Account Agreement and Disclosures.


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