Program Evaluation Form

Credit Union Information

Contact Information

Credit Union Name: *

Contact Name: *

First

Last

Credit Union Address:

Address Line 1

Address Line 2

City

State

Zip Code

Contact Title:

Contact Email: *

Contact Phone:

Current Number of Share Draft Checking Accounts:

Current Number of Share Draft Checking Accounts with 1 (or more) active debit cards:

Core Processor:

ATM/Debit Card Processor:

Courtesy Pay/Overdraft Program

Do you currently offer a Courtesy Pay Overdraft protection to your members?

When did you implement your Courtesy Pay Overdraft program (MM/YY)?

Did you implement it through your core processor or a third party?

Core Processor
Third Party

What is the name of the third party used?

When does your contract expire with the third party (MM/YY)?

Is your Courtesy Pay Overdraft limit included for approval of ATM and POS transactions?

What Overdraft limit(s) do you offer?

Do you charge a daily overdraft fee?

If yes, how much do you charge and when do you start charging?

What is the fee to PAY a negative item?

What is the fee to RETURN a negative item?

How many Share Draft Checking Accounts currently have a Courtesy Pay Overdraft limit?

How many Share Draft Checking Accounts have opted in, per Reg E, for a Courtesy Pay Overdraft program coverage on their Debit/ATM card?

Total NSF/OD Income

Q1 2021 NSF/OD Income

Q1 2021 # of Negative Items PAID

Q1 2021 # of Negative Items RETURNED

Q2 2021 NSF/OD Income

Q2 2021 # of Negative Items PAID

Q2 2021 # of Negative Items RETURNED

Q3 2021 NSF/OD Income

Q3 2021 # of Negative Items PAID

Q3 2021 # of Negative Items RETURNED

Q4 2021 NSF/OD Income

Q4 2021 # of Negative Items PAID

Q4 2021 # of Negative Items RETURNED

January 1-Present 2022 NSF/OD Income

January 1-Present 2022 # of Negative Items PAID

January 1-Present 2022 # of Negative Items RETURNED

Of the total NET NSF/OD and Courtesy Pay income, estimate the percentage of ATM/POS income:

How did you hear about us?

Postcard
Phone Call
Email
Referral
Conference
LinkedIn
Internet Search

Evaluate Your Program

Credit Union Information

Contact Information

Courtesy Pay/Overdraft Program

Total NSF/OD Income

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