Privilege Pay ATM & Debit Card Purchase Opt-in / Revocation Form

What You Need to Know About Overdraft Fees

If you have multiple checking accounts, please register each individually.

* Required Information

First Name:	*
Last Name:	*
Member Number:	*
Verify Member Number:	* (enter twice)
Email Address:	*
Verify Email Address:	* (enter twice)
YOUR AGREEMENT:	By agreeing to have my overdrafts paid by the credit union, I understand that I have a right to revoke or change my election at any time. The revocation must be provided in writing. In addition, I agree to receive my opt-in confirmation via the email address I have listed above. I want 1st MidAmerica Credit Union to authorize and pay overdraft on my ATM and everyday debit card transactions. I do not want 1st MidAmerica Credit Union to authorize and pay overdraft on my ATM and everyday debit card transactions. By choosing this option, the credit union will not authorize and pay these transactions after August 15, 2010.