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APPLICATIONFOR VISA@CHECKCARD
DEPOSITOR
JOINTDEPOSITOR
Name (First- Middle- Last)
AccounN
t umber
lssueanothercard in this
n a m e :[ v " .
Name (First- Middle- Last)
Address(if differentfrom depositor)
Address
City
City
Home Telephone
Rent
Own home
ur
Zip Code
SocialSecuritvNumber
Zip Code
State
How LongAt This Address
State
INo
EMPLOYER
JOINTDEPOSITOR'S
How Long?
Live w/parents
I
MonthlyRenVMortgage
Address
PreviousAddress(lf LessThanThreeYearsAt PresentAddress)
City
DateOf Birth
Position-Job
Title
SociaS
l e c u r i t yN u m b e r
Mother's Maiden Name
DEPOSITOR'S
EMPLOYER
State
Zip Code
T e l e o h o n eN u m b e r
request(s)
the described
Signatures:By signingbelow,the undersigned
servicesand agreesto the termsand conditionsgoverningthe services,
i n c l u d i n ga n y f e e s a n d c h a r g e s T
. he undersignea
d g r e e ( s )t h a t a l l
is accurateand authorizes
information
the financialinstitution
to verifu
c r e d i ta n d e m p l o y m e nht i s t o r yb y a n y n e c e s s a r ym e a n s ,i n c l u d r n !
preparation
of a creditreportby a creditrepodingagency.
Signatureo{ Depositor
Address
Signatureof Joint Depositor
City
Zip Code
Position-Job
Title
Telephone
Number
N O T I C E :Y o u n e e d n o t l i s t i n c o m ef r o m a l i m o n y c, h i l ds u p p o r t
or separatemaintenance
if you do not want it considered.
M a i lo r d e l i v e ra p p l i c a t i otno :
I N E ZD E P O S I TB A N K
P . O .B O X3 6 5
I N E Z .K E N T U C K Y
41224
(Please
CURRENT
DEBTS
attachanother
sheetif additional
spaceis needed)
( c h e c ko n e o r b o t h )
\
o
FUND
ELECTRONIC
TRANSFERS
YOUR
RIGHTS
ANDRESPONSIBILITIES
lmportant lnformation About Procedures lor Opening a New Account.
To help the government fight the funding of terrorismand money laundering
activities,Federal law requires all financial institutionsto obtain, verify, and
record informationthat identifieseach person who opens an account.
What this means for you: When you open an account, we will ask for your
name, address, date of birth, and other intormation that will allow us to
identifyyou. We may also ask to see your driver'slicense or other
identifyingdocuments.
Indicatedbelow are types of ElectronicFund Transferswe are capable
of handling, some of which may not apply to your account. Please read this
disclosure carelully because it tells you your rights and obligationsfor the
transactionslisted.You should keep this notice for future reference.
ATM Transfers - types of transfers, dollar limitations, and charges You may access your account(s) by AfM using your VISA@ Check Card
and personal identificationnumber, to:
. make deposits to checkingaccount(s)with a debit card
o get cash withdrawalsfrom checking account(s)with a debit card
- Dollar limitationswill be disclosedin writingat card issuance.
- there is a charge of $1 .00 per withdrawalat ATMs we do not own
or operate
. get cash withdrawalsfrom savings account(s)with a debit card
- Dollar limitationswill be disclosedin writingat card issuance.
- there is a charge of $1.00 per withdrawalat ATMs we do nol own
or ooerale
. transfer funds from savingsto checking account(s)with a debit card
. transfer funds from checkingto savings account(s)with a debit card
. make payments from checking account(s) with a debit card to loan
accounts with us
. gel informationabout:
- the account balance of your checkingaccounts
. with a debit card
- the account balance of your savings accounts
. with a debit card
Some of these services may not be availableat all terminals.
Please also see Limitations on frequency of transfers section regarding
limrtationsthat apply to ATM transfers.
Types of VISA Check Card Point-of-Sale Transactions - You may
access your checking account(s) to purchase goods (in person or by
phone), pay for seryices (in person or by phone), get cash from a merchant,
if the merchant permits, or from a participatingfinancialinstitution,and do
anything that a participatingmerchantwill accept.
Point-of-Sale Transactions - dollar limitations, and charges - Using
your card:
. Dollar limitationswill be disclosed in writingat card issuance.
. the charge for your card (whether or not the card is used in the
p e r i o d )i s $ 1 . 0 0 p e r m o n t h
Please also see Limitations on frequency of transfers section regarding
limitationsthat apply to debit card transactions.
Currency Conversion and International Transactions. When you use
your VISA@ Check Card at a merchant that settles in currency other than
US dollars, the charge will be converted into the US dollar amount. The
currency conversion rate used to determine the transactionamount in US
dollars is either a rate selecled by Visa from the range of rates availablein
w h o l e s a l e c u r r e n c y m a r k e t s f o r t h e a p p l i c a b l ec e n t r a l p r o c e s s i n gd a t e ,
which rate may vary from the rale Visa itself receives,or the governmenlm a n d a t e d r a t e i n e f f e c t f o r t h e a p p l i c a b l ec e n t r a l p r o c e s s i n gd a t e . T h e
conversion rate in effect on the processingdate may differ from the rate in
eftect on the transactiondate or posting date.
V i s a U S A c h a r g e s u s a . 8 9 . tI n t e r n a t i o n a S
l e r v t c e A s s e s s m e n to n a l l
i n t e r n a t i o n a lt r a n s a c t i o n s ,r e g a r d l e s so f w h e t h e r t h e r e i s a c u r r e n c y
l ervice
c o n v e r s i o n . l f t h e r e i s a c u r r e n c y c o n v e r s i o n ,t h e I n t e r n a t i o n a S
A s s e s s m e n t i s l % o f t h e t r a n s a c t i o n .I n e i t h e r c a s e , w e p a s s t h i s
i n t e r n a t i o n a lt r a n s a c t i o nf e e o n t o y o u . A n i n t e r n a t i o n atl r a n s a c t i o ni s a
transactionwhere the country ol the merchant is outsidethe USA.
Advisory Against lllegal Use. You agree not to use your card(s) for illegal
gambling or other illegal purpose. Display of a payment card logo by, for
example, an online merchant does not necessarilymean that transactions
are lawful in all jurisdictionsin which the cardholdermay be located.
Non-Visa Debit Transaction Processing. We have enabled non-Visa debit
transactionprocessing.This means you may use your Visa-brandeddebit
card on a PIN-DebitNetwork-(a non-Visanetwork)withoutusing a PlN.
The non-Visadebit network(s)lor which such transactionsare enabled are:
PULSE and NYCE Networks.
Examples of the types of aclions that you may be required to make to
initiatea Visa transactionon your Visa-brandeddebit card include signing
a receipt, providing a card number over the phone or via the Internet, or
swiping the card through a point-of-saleterminal.
Examples of the types of aclions you may be required to make to initiate a
transaction on a PIN-Debit Network include initiating a payment directly
w i t h t h e b i l l e r ( p o s s i b l yv i a t e l e p h o n e , I n t e r n e t ,o r k i o s k l o c a t i o n s ) ,
responding to a logo displayed at a payment site and choosing to direct
payment through that network,and having your identityverified using
known informationderived from an existing relationshipwith you instead of
through use ol a PlN.
The provisionsof your agreement with us relatingonly to Visa transactions
are not applicable to non-Visa lransactions. For example, the additional
limits on liability (sometimes referred to as Visa's zero-liabilityprogram)
and the streamlinederror resolutionproceduresoffered on Visa debit card
transactionsare not applicableto transactionsprocessed on a PIN-Debit
Network.
-Visa Rules generally define P/i/-Debit Network as a non-Visa debit
n e t w o r k t h a t t y p i c a l l y a u t h e n t i c a t e st r a n s a c t i o n sb y u s e o f a p e r s o n a l
identificationnumber (PlN) but that is not generally known for having a
card program.
Limitations on frequency of transfers. In addition to those limitationson
transferselsewheredescribed,if any, the followinglimitationsapply:
. T r a n s f e r st r o m a s a v i n g s a c c o u n t t o a n o t h e r a c c o u n t o r t o t h i r d
parties by preauthorized,automatrc,or telephonetransfer are limited
to six per month with no more than three by check, draft, debit card,
or similarorder to third parties.
FEES
. We will charge you $5.00 for a new debit card personal identification
numDer.
. We will charge $10.00 to replace a card that is lost. (Not presented
at the time of request)
. We will charge $5.00 to replace a card that is presented at the time
of reouest.
ATM Operator/Network Fees. When you use an ATM not owned by us,
you may be charged a fee by the ATM operator or any network used (and
you may be charged a fee lor a balance inquiryeven if you do not
complete a fund transfer).
DOCUMENTATION
. Terminal transfers. You can get a receipt at the time you make a
transfer to or from your accounl using an automated teller machine
or point-of-saleterminal. However, you may not get a receipt if the
amount of the transferis $15 or less.
. Periodic statements.
You will get a monthly account statement from us lor your
checking accounts.
You will get a monthly account statement from us for your
savings accounts, unless there are no transfers in a particular
month. In any case, you will get a statementat least quarterly.
FINANClAL INSTITUTION'SLIABILITY
Liability for lailure to make transfers. lf we do not complete a
transferto or from your account on time or in the correct amount according
to our agreement with you. we will be liable for your losses or damagesl
However,there are some exceptions.We will not be liable,for instance:
(1) lf, through no fault of ours, you do not have enough money in your
account to make the trans{er.
(2) lt you have an overdraft line and the transfer would go over the
c r e d i tl i m i t
(3) lf the automatedteller machine where you are making the transfer
does not have enough cash.
(4) lf the terminal or system was not working properly and you knew
about the breakdownwhen you startedthe transfer.
(5) lf circumstancesbeyond our control (such as fire or flood) prevent
the transfer,despite reasonableprecautionsthat we have taken.
(6) There may be other exceptionsstated in our agreement with you.
CONFIDENTIALITY
We will disclose intormalionto third parties aboul your account or the
transfersyou make:
(1) where it is necessaryfor completingtransfers;or
(2) in order to verify the existenceand conditionof your account for a
third party, such as a credit bureau or merchant;or
(3) in order to comply with government agency or court orders;
or
(4) as explained in the separate Privacy Disclosure.
UNAUTHORIZED TBANSFERS
(a) Consumer liability.
. Generally. Tell us AT ONCE if you believe your card and/or
code has been lost or stolen. or if vou believe that an electronicfund
triinsfer has been made without your permission using information
from your check. Telephoning is the best way of keeping your
possible losses down. You could lose all the money in your accounl
(plus your maximum overdraft line ol credit). lf you tell us within 2
business days after you learn of the loss or theft of your card and/or
code, you can lose no more than $50 if someone used your card
and/or code without your permission.
ll you do NOT tell us within 2 business days after you learn of
the loss or theft of your card and/or code, and we can prove we
could have stopped someone from using your card and/or code
without your permission if you had told us, you could lose as much
as $500.
Also, if your statement shows transfers that you did not make,
includingthose made by card, code or other means, tell us at once.
lf you do not tell us within 60 days after the statement was mailed to
you, you may not get back any money you lost after the 60 days if
we can prove that we could have stopped someone from taking the
money if you had told us in time.
lf a good reason (such as a long trip or a hospitalstay) kept you
from telling us, we will extend the time periods.
. Additional Limit on Liabilitv for VISA@ Check Card. Unless vou
have been grossly negligent oi have engaged in fraud, you will not
be liable for any unauthorizedtransactionsusing your lost or stolen
VISA@ Check Card. This additionallimit on liabilitydoes not apply to
ATM transactions or to transactionsusing your Personal
ldentificationNumber which are nol processedby VISA@.
(b) Contact in event ol unauthorized transfer. lf you believe
your card and/or code has been lost or stolen, call or write us at the
telephone number or address listed in this brochure.You should also
call the number or write to the address listed in this brochure if you
believe a transfer has been made using the inlormation from your
check without your permission.
ERROR RESOLUTION NOTICE
In Case of Errors or Questions About Your ElectronicTransfers,
Call or Write us at the telephone number or address listed in this
brochure, as soon as you can, if you think your stalement or receipt
is wrong or if you need more intormationabout a transfer listed on
the statement or receipt. We must hear from you no later than 60
days after we sent the FIRST statement on which the problem or
error appeareo.
( 1 ) T e l l u s y o u r n a m e a n d a c c o u n tn u m b e r( i f a n y ) .
(2) Describe the error or the transfer you are unsure about, and
explain as clearly as you can why you believe it is an error
or why you need more information.
(3) Tell us the dollar amount of the suspectederror.
lf you tell us orally, we may require that you send us your
complaintor question in writing within 10 business days.
We will determine whether an error occurred within 10 business
days (5 business days lor VISA@Check Card point-of-sale
transactionsprocessed by Visa and 20 business days if the transfer
involved a new account) after we hear from you and will correct any
error promptly. lf we need more time, however.we may take up to 45
days (90 days if the transfer involved a new account, a point-of-sale
transaction, or a foreign-initiatedtransfer) to investigate your
c o m p l a i n to r q u e s t i o n .l f w e d e c i d e t o d o t h i s , w e w i l l c r e d i t y o u r
account within 10 business days (5 business days for VISA@ Check
Card point-of-saletransactionsprocessed by Visa and 20 business
days if the transfer involved a new account) for the amount you think
is in error, so that you will have the use of the money during the time
it takes us to complete our investigation.lf we ask you to put your
complaint or question in writing and we do nol receive it within 10
business days, we may not credit your account. Your account is
considered a new account for the first 30 days after the first deposit
is made, unless each of you already has an establishedaccount with
us belore this account is opened.
We will tell you the results within three business days a{ter
completingour investigation.lf we decide that there was no error, we
will send you a written explanation.
You may ask for copies of the documents that we used in our
investigation.
32489S1-020
I N E Z D E P O S I TB A N K
B O O K K E E P I N GD E P A R T ME N T
P.O.BOX 365
I N E Z , K E N T U C K Y4 1 2 2 4
Business Days: Monday through Friday
ExcludingFederal Holidays
Phone: (606) 298-3511
M O R E D E T A I L E D I N F O R M A T I O NI S A V A I L A B L EO N R E Q U E S T
NOTICE OF ATM/NIGHT DEPOSIT
FACILITY USER PRECAUTIONS
A s w i t h a l l f i n a n c i a l t r a n s a c t i o n s .o l e a s e e x e r c i s e d i s c r e t i o n
when using an automatedteller machine (ATM) or night deposit
facility. For your own safety, be careful. The following suggestions
may be helpful.
1.
Prepare for your transactionsat home (for instance,by filling
out a deposit slip) to minimize your time at the ATM or night
deposit facility.
2.
Mark each transactionin your account record, but not while
at the ATM or night deposit facility.Always save your ATM
r e c e i p t s .D o n ' t l e a v e t h e m a t t h e A T M o r n i g h t d e p o s i t
f a c i l i t y b e c a u s e t h e y m a y c o n t a i n i m p o r t a n ta c c o u n t
information.
3.
Compare your records with the account statementsyou
recerve.
4.
Don't lend your ATM card to anyone.
5.
Remember, do not leave your card at the ATM. Do nol leave
any documents at a night depositfacility.
Protect the secrecy of your Personal ldentificationNumber
(PlN). Protect your ATM card as though it were cash. Don't
tell anyone your PlN. Don't give anyone information
regarding your ATM card or PIN over the telephone. Never
enter your PIN in any ATM that does not look genuine, has
been moditied, has a susprciousdevice atlached, or is
o p e r a t i n g i n a s u s p i c i o u sm a n n e r . D o n ' t w r i t e y o u r P I N
where it can be discovered.For example. don't keep a note
of your PIN in your wallet or purse.
7.
Prevent others from seeing you enter your PIN by using your
body to shield their view.
lf you lose your ATM card or if it is stolen, promptlynotily us.
You should consult the other disclosuresyou have received
a b o u t e l e c t r o n i cf u n d t r a n s f e r s l o r a d d i t i o n a l i n l o r m a t i o n
about what to do il your card rs lost or stolen.
L
When you make a transaction,be aware of your
surroundings.Look out for suspiciousactivity near the ATM
or night deposit facility, particularlyif it is after sunset. At
night, be sure that the facility(includingthe parking area and
w a l k w a y s ) i s w e l l l i g h t e d .C o n s i d e r h a v i n g s o m e o n e
accompany you when you use the facility, especially after
sunset. ll you observe any problem, go to another ATM or
night deposit facility.
1 0 Don't acceot assistancefrom anvone vou don't know when
using an AiM or night deposit taiitity.
l f y o u n o t i c e a n y t h i n g s u s p i c i o u so r i f a n y o t h e r p r o b l e m
arises after you have begun an ATM transaction,you may
want to cancel the transaction,pocket your card and leave.
You might consider using another ATM or coming back later.
t 1
Don't display your cash; pocket it as soon as the ATM
transaclion is completed and count the cash later when you
are in the safety of your own car, home, or other secure
surrounorng.
1 3 At a drive-up facility,make sure all the car doors are locked
and all of the windows are rolled up, except the driver's
window. Keep the engine running and remain alert to your
surroundings14
We want the ATM and night deposit facility to be safe and
convenient for you. Therefore, please tell us il you know of
any problem with a facility.For instance,let us know il a light
is nol working or there is any damage to a facility. Please
report any suspiciousactivityor crimes to both lhe operator
of the facility and the local law enforcement officials
immediately.
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O 1996 Wolters Kluwer Financial Services - Bankers SvstemsrM
Form CARD-BRO 5/15/96 Custom 2av
3248991-020
INEZ.WARFIELD- LOUISA
P.O. Bor 365, Inoz, KY 11224
606.298.3511
606.638.9461