Opt-In Enrollment Form

NOTE: Items beginning with * are required. * First Name: * Last Name: * Member Number: Email Address: Daytime Phone: -- * I have read the information below. Please select the appropriate box to the right. Yes - I want Rivermark to authorize and pay overdrafts on my everyday debit card and ATM transactions No - Please revoke my previous decision to opt in to Courtesy Pay for my debit card and ATM transactions *For security reasons, please enter the code shown in the below image:

What You Need To Know about Overdrafts and Overdraft Fees

An overdraft occurs when you do not have enough money in your account to cover a transaction, but we pay it anyway. We can cover your overdrafts in two different ways:

1. We offer Overdraft Protection plans that transfer funds from a savings, Visa or line of credit account.
2. We have standard overdraft practices (our Courtesy Pay program) that come with your account.

What are the standard overdraft practices that come with my account?

1. We authorize and pay overdrafts for the following types of transactions:
   
   
   • Checks and other transactions made using your checking account number
   • Automatic bill payments
   • Recurring debit card transactions
   • Automated Clearing House (ACH) withdrawals - Like a gym membership that is automatically paid from your checking account
     
     
2. If you ask us to, we authorize and pay overdrafts for everyday debit card transactions as described below.
   
   
   • Everyday debit card purchases in which you do not enter your PIN (which are commonly used for restaurants, gas stations, large-ticket items, travel, movie rental kiosks and parking/Tri-Met payment stations).
   • Everyday debit card transactions in which you enter your PIN at checkout.
   • ATM withdrawals or transfers.

We pay overdrafts at our discretion, which means we do not guarantee that we will always authorize and pay any type of transaction.

What fees will be charged if Courtesy Pay is used to pay overdrafts?

• We will charge you a fee of $30 each time we pay an overdraft.
• There is no limit on the total fees we can charge you for overdrawing your account.
• If a debit card transaction overdraws your account by $5 or less, the overdraft fee will be refunded to your account the following business day.

What if I want Rivermark to authorize and pay overdrafts on my ATM and one-time debit card transactions?

Simply check the "Yes" box above and submit this form. If you wish to revoke your previous decision to opt in to Courtesy Pay for your ATM and everyday debit card transactions, you can opt out by checking the appropriate box above or you can call 503.626.6600 or 800.452.8502.