Can this be signed electronically?

Yes in most cases. Electronic signatures are legally effective under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states unless the record is an excluded category such as wills or certain court filings.

Do I need a notary or witness?

Not usually for ordinary disclosures, but certain instruments or state-specific statutes may require notarization or witnesses; confirm local rules before omitting a notary.

What authentication level is sufficient?

For routine commercial disclosures, email or SMS authentication plus an audit trail is typical; use KBA or stronger methods for higher-risk or regulated transactions.

How long must I retain executed copies?

Retention depends on document type and industry: IRS rules generally require three years (IRC §6501(a)), HIPAA six years (45 CFR §164.530(j)), and state law may impose longer periods.

What if party names don’t match?

Mismatched names can create enforceability risks. Correct legal names before signing and attach corporate formation documents or power-of-attorney as needed.

Are consumer disclosures required?

Yes for many consumer-facing transactions: ESIGN requires clear consumer disclosure of the right to paper, demonstration of access, and a method to withdraw consent (15 U.S.C. §7001(c)).

Electronic Signature
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Agreement Disclosure Statement

Agreement Disclosure Statement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

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 (hereinafter referred to as NBI, we, our, or us).

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.

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.

A transaction which results in an overdraft to your Checking Account may be treated as your request for a Cash Advance from your Credit Card Account, as indicated in the “Overdrafts” section under “Additional Fees and Terms”. You may not obtain a cash advance if your Account is delinquent, closed or the amount of the advance requested would cause your balance to go over your credit limit.

You agree to the following terms and conditions and any amendments thereto. By requesting and receiving, signing, using or permitting others to use a Credit Card (hereafter referred to as “Credit Card”) issued to you by NBI, you agree as the cardholder to the following terms:

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. Any financial service provided by the NBI may only be used for any transaction permitted by law.

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. NBI must receive the written request in time to afford a reasonable opportunity to act upon it by their rules. A stop payment is only honored for six (6) months.

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 where the delay or misrouting is caused by markings placed on the check by you or a prior endorser that obscure any depository endorsement placed by NBI or its agent.

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. At the request of NBI, you agree to return the Credit Card. You are responsible for safekeeping of the Credit Card.

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. A delay of up to three (3) business days may occur in the posting of payments and credits to your account, during which time your available credit limit will not reflect recent payments and credits.

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 of transactions which initially occurred in a different currency.

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

You can avoid FINANCE CHARGES on purchases by paying the full amount of the new balance of purchases each month within 25 days of the statement closing date.

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

The current Daily Periodic Rate used in calculating the Finance Charge on Gold is which currently corresponds to an ANNUAL PERCENTAGE RATE of .

H. CALCULATION OF AVERAGE DAILY BALANCE: We calculate the Average Daily Balance (the balance which is subject to the Daily Periodic Rate) 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 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: Merchants and others who honor the Credit Card may give credit for returns or adjustments, and they will do so by sending us a credit that we will post to your account.

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.

Your notification address:

N. LOST OR STOLEN CARD OR PIN: If you believe your Card and/or PIN has been lost or stolen or that someone has transferred or may transfer money from your account without your permission, call us immediately at .

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 your letter, give us the following information:

Your name and account number.

The dollar amount of the suspected error.

Describe the error and explain, if you can, why you believe there is an error.

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

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.

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.

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: For your protection, your Card is issued with an expiration date.

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: You understand and agree that 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 or obtain in the future 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; or

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

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

4. If you have made or do make any false or misleading statements in furnishing financial and other information to NBI; or

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

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

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

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

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.

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.

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

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

Late Charge: will be assessed if payment is not received within 10 days of due date.

Over-limit Charge: may be assessed if balance exceeds credit limit.

Replacement Cards: fee for a replacement card.

Copies of Transaction Slips: per copy.

Duplicate Statements: per duplicate copy.

Research Charges: for account research.

Card Recovery Charge: minimum .

SAFETY TIPS FOR USING YOUR CREDIT CARD

 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.

 Be aware of your surroundings.

 Consider having another person accompany you to the ATM.

 When using an ATM, shield your actions.

 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.

 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 (ANY AND ALL PROCEEDS THEREOF), IF ANY, 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.

Applicant Signature

Date

Co-Applicant Signature

Date

Printed Name

Account Number

What an Agreement Disclosure Statement Is and When it’s Used

An Agreement Disclosure Statement is a written record attached to a contract that itemizes material disclosures, conflicts of interest, fees, payment terms, and other facts the parties must know before contractual performance begins. It clarifies obligations, documents consent, and provides a consistent reference for interpretation, audits, and regulatory review. In many U.S. transactions the statement supports consumer- or business-facing disclosure obligations and can be executed electronically under the ESIGN Act (15 U.S.C. ch. 96) and state UETA laws when no statutory exception applies.

Why including an Agreement Disclosure Statement matters

A clear disclosure statement reduces disputes, documents informed consent, and helps satisfy statutory consumer-disclosure requirements under federal and state law.

Who typically prepares and signs this statement

The Agreement Disclosure Statement is used by contract drafters, corporate counsel, sales teams, HR, compliance officers, and agents who need to communicate material facts to counterparties.

Corporate Counsel and Compliance — Legal teams draft standardized statements to ensure consistent disclosures across transactions and to reduce regulatory risk.
Sales and Operations Teams — Front-line staff attach the statement to customer contracts to explain fees, service levels, and cancellation terms.
Authorized Agents and Brokers — Real estate, insurance, and financial services professionals supply disclosures required by state law or industry rules.

Different industries adapt the form to their regulatory needs; the following roles commonly prepare or execute the statement.

Essential parts of a professional Agreement Disclosure Statement

A useful disclosure statement is concise, clearly headed, and organized so each material topic is separable and actionable for signers and reviewers.

Parties

Full legal names and roles for each contracting party, including entity type and signatory authority, to avoid later identity disputes.

Effective Date

The date the disclosure and associated agreement become operative, stated in MM/DD/YYYY format to fix timing for obligations.

Material Terms

Summarize fees, payment schedule, refunds, performance milestones, and termination triggers in plain language for clarity.

Conflicts & Affiliations

Disclose relationships, referral fees, or ownership interests that could create a conflict of interest for transparency and compliance.

Legal Notices

Call out required statutory notices (consumer rights, HIPAA authorizations, FERPA exceptions) and include the applicable citation where required.

Signature Block

Space for printed name, title, signature, date, and identification of the person with authority to bind the party.

Step-by-step: completing and delivering the disclosure

Follow these four practical steps to prepare, sign, and document the Agreement Disclosure Statement for enforceability and auditability.

01

Draft: Populate parties, material items, dates, and governing law.
02

Review: Legal or compliance reviews content for completeness and required statutory language.
03

Sign: Execute by authorized signers—electronic signatures are allowed where no statutory exception applies.
04

Archive: Store the executed record with an audit trail and retention metadata.

Typical routing and eSubmission flow

A predictable workflow reduces signer friction and ensures each execution is properly authenticated and recorded.

Upload Document: Sender uploads the disclosure and attaches it to the primary contract.
Place Fields: Insert signature, initials, and date fields where required.
Invite Signers: Send secure signing links or email invitations to each signer in order.
Capture Audit Trail: Record timestamps, IP addresses, and authentication method for each action.

Recommended digital workflow settings for e-execution

Configure these settings when preparing the form for electronic signing to preserve legal validity and reduce processing errors.

Field	Configuration
Signing Order	Set sequential or parallel routing per transaction needs.
Authentication	Use email link or SMS code; consider KBA for higher risk transactions.
Conditional Fields	Enable show/hide logic to surface only relevant disclosures to each signer.
Retention Metadata	Attach document tags for retention period and matter ID.

Technical considerations for eSigning and storage

Choose a platform that supports common file types, audit trails, and the authentication level your transaction requires.

File Formats: PDF, DOCX, and HTML-supported uploads are standard.
Integrations: CRM/ERP integrations (Salesforce, NetSuite, Microsoft 365) improve routing.
Authentication: Email, SMS, KBA, and advanced signer authentication options.

Timing: when to deliver and how long processing takes

Set clear delivery expectations so recipients have time to review disclosures and avoid last-minute disputes or statutory notice issues.

Deliver Before Execution:

Provide disclosures before contract signing to document informed consent.

Review Window:

Allow at least 3–5 business days for complex disclosures or regulated transactions.

Signature Completion:

Electronic signing often completes within 24–72 hours for routine matters.

Retention Start:

Retention periods begin on the effective date or last effective amendment.

Audit Availability:

Ensure audit trails are exportable immediately after execution.

Common preparation errors to avoid

Mismatched party names: using trade names or initials instead of the full legal name causes identity and enforcement issues.
Missing effective date: an absent or ambiguous date can delay performance triggers and retention timelines.
Omitting required consumer disclosure: consumer-facing transactions need ESIGN consumer disclosure and demonstrable consent when required under 15 U.S.C. §7001.
Using informal initials only: initials may be insufficient unless the document explicitly allows them; require full signature where legal intent is needed.

Material risks and potential penalties for defective disclosures

Tax Reporting Penalties: Failure to produce accurate info returns can trigger IRC §6721 fines.

Contract Voidance: Material nondisclosure may render a contract voidable.

Regulatory Fines: Consumer-protection breaches can result in agency penalties.

HIPAA Violations: Improper handling of PHI risks HIPAA enforcement and BAA breaches.

Notarization Failures: Missing notarization where required can invalidate the instrument.

I-9 Noncompliance: I-9 paperwork errors can produce DHS fines per 8 CFR §274a.2.

Key milestones from draft to archival

Track milestones so stakeholders know when disclosures must be prepared, delivered, signed, and archived to meet legal and operational requirements.

01

Draft Finalization

Complete disclosure language and internal approvals before delivery to the counterparty.

02

Delivery to Recipient

Provide disclosures in advance of signing to document informed consent.

03

Execution and Capture

Obtain signatures and capture audit trail, timestamps, and authentication details.

04

Archive and Retain

Export signed PDF and metadata to records system and apply retention tags.

Representative eSignature vendor comparison for executing disclosures

Compare core pricing and capability notes for common eSignature providers when planning disclosure execution. signNow appears first for direct comparison.

	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 card	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes (Business Premium)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about Agreement Disclosure Statements

Answers to common preparation, execution, and compliance questions to help avoid routine errors when using disclosure statements.

Need help? Contact support

Can this be signed electronically?
Yes in most cases. Electronic signatures are legally effective under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states unless the record is an excluded category such as wills or certain court filings.
Do I need a notary or witness?
Not usually for ordinary disclosures, but certain instruments or state-specific statutes may require notarization or witnesses; confirm local rules before omitting a notary.
What authentication level is sufficient?
For routine commercial disclosures, email or SMS authentication plus an audit trail is typical; use KBA or stronger methods for higher-risk or regulated transactions.
How long must I retain executed copies?
Retention depends on document type and industry: IRS rules generally require three years (IRC §6501(a)), HIPAA six years (45 CFR §164.530(j)), and state law may impose longer periods.
What if party names don’t match?
Mismatched names can create enforceability risks. Correct legal names before signing and attach corporate formation documents or power-of-attorney as needed.
Are consumer disclosures required?
Yes for many consumer-facing transactions: ESIGN requires clear consumer disclosure of the right to paper, demonstration of access, and a method to withdraw consent (15 U.S.C. §7001(c)).

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