IVR Balance Inquiry Fee Disclosure
Please review the fee disclosure below and acknowledge your understanding regarding fees for balance inquiries via our IVR system.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
The Last 4 Digits of Your Account or Card
*
Preferred Method for Receiving Fee Disclosures
*
Email
SMS/Text Message
Postal Mail
IVR Balance Inquiry Fee Amount (as disclosed)
*
How often do you use IVR balance inquiry services?
Daily
Weekly
Monthly
Rarely
Do you agree to be charged the disclosed fee for IVR balance inquiries?
*
Yes, I acknowledge and agree to the disclosed fee.
No, I do not agree.
Comments or Questions (optional)
Date of Acknowledgment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please sign below to confirm receipt and understanding of the IVR balance inquiry fee disclosure.
*
Submit
Submit
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