Small Dollar Lending Rule Disclosure Testing (Payday)

Generic Clearance for Development and/or Testing of Model Forms, Disclosures, Tools, and Other Similar Related Materials

Draft Payment Forms 7-16-15

Small Dollar Lending Rule Disclosure Testing (Payday)

OMB: 3170-0022

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DRAFT – FOR TESTING PURPOSES ONLY

XYZ Company
800-121-0090
xyzco.com/xox302ksw

Upcoming Withdrawal Notice
from XYZ Company
On November 7, 2015, XYZ Company will seek to withdraw a payment
of $40 from your account ending in 0022. The payment will be made
by check, using check # 999.
If this payment is successful, your remaining balance for loan #5432 will be
$400. If this payment is not successful, a failed payment fee of $25 will be
added to your loan balance. This loan was made to you at a 533.20%
annualized percentage rate of interest.
Contact XYZ Company at 1-800-121-0090 if you have questions
or need to stop this withdrawal. Your account-holding institution also may
be able to provide some assistance.

DRAFT – FOR TESTING PURPOSES ONLY

XYZ Company
800-121-0090
xyzco.com/xox302ksw

Unusual Withdrawal Alert from
XYZ Company
On November 7, 2015, XYZ Company will seek to withdraw a payment
of $80 from your account ending in 0022. The payment will be made
by ACH.
This payment is unusual because it is larger than the previous withdrawal.
The previous withdrawal was initiated on November 2, 2015, for $60.
If this payment is successful, your remaining balance for loan #5432 will be
$400. If this payment is not successful, a failed payment fee of $25 will be
added to your loan balance.
Contact XYZ Company at 1-800-121-0090 if you have questions or need
to stop this withdrawal. Your account-holding institution also may be able
to provide some assistance.

DRAFT – FOR TESTING PURPOSES ONLY

XYZ Company
800-121-0090
xyzco.com/xox302ksw

Notice: Company XYZ can no
longer withdraw loan payments
from your account
Our last two attempts to withdraw payment on your loan #5432 from
your account ending in 0022 were returned because your account did
not contain enough funds to cover the payment. As a result, Federal
law prohibits us from making additional attempts to withdraw payment
from your account.
You may still owe the outstanding balance on this loan. If you wish to
learn more about your payment options, please call us at 1-800-1211190 or visit xyzco.com/xox302ksw.

Dates and amounts of returned payment attempts:
Date

Amount Attempted

Fees charged by Company XYZ

November 7, 2015

$40

$25 failed payment fee

November 10, 2015

$40

$25 failed payment fee

NOTE FROM THE CONSUMER FINANCIAL PROTECTION BUREAU

To learn more about your rights as a borrower, visit
consumerfinance.gov/ask-cfpb/


File Typeapplication/pdf
File TitleMicrosoft Word - Draft Payment Forms 7-16-15
AuthorFrattarolis
File Modified2015-07-16
File Created2015-07-16

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