Girard National Bank
Girard National Bank 620-724-8223
Yates Center Branch Bank 620-625-2125
Bucklin National Bank 620-826-3221
Offerle National Bank 620-659-2121
Clay County National Bank 785-632-6720
Holton National Bank 785-364-2166
Horton National Bank 785-486-2124
Hiawatha National Bank 785-742-3005
Wetmore National Bank 785-866-2920
Valley National Bank 719-336-4381
Kiowa County National Bank 719-438-5331

Opt-In Consent Form

Your response required to keep overdraft privilege on your debit card.

Do you like the way your account works now for debit card purchases and ATM withdrawals? If so, it's important that you choose to Opt In. Effective August 15th, a change in federal regulations will require banks to no longer honor one time debit card purchases or ATM withdrawals which might overdraw your account unless an Opt In form is completed.

An overdraft occurs when there is not enough money in the account to cover a transaction(s) but the bank covers the payment(s). There are two ways an overdraft can be covered: standard overdraft practices or Overdraft Privilege Service. With our standard overdraft practices, the bank will consider, but does not guarantee, the authorization and payment of your checks and other selected transactions. The bank will NOT authorize and pay ATM transactions or or debit card transactions with standard overdraft practices. However, by "Opting In" the bank will consider payment of ATM transactions and Debit Card Transactions.

By submitting the information below, I give my consent to authorize and pay overdrafts on my ATM and Debit Card transactions utilizing Overdraft Privilege Service. I understand I may be charged a $29 fee per overdraft item (no limit) and subject to a $4 per day fee beginning the third day with a negative balance and additional merchant fees may apply. My consent is specific to the accounts listed below. I understand I can revoke my consent at any time by contacting the bank.

Yes, "Opt In" the accounts I have listed below. I am the owner or a joint account owner
on these eligible account(s):

IMPORTANT: For security reasons, please list ONLY the LAST FOUR numbers of each account number below.


If you have previously opted in, and wish to opt-out, click here.

Created by: Rossini.com