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REG E OPT-IN CONSENT

I want the financial institution to authorize and pay overdrafts on my ATM and everyday debit card transactions. If this is a joint account, any account holder may consent on behalf of the other account holder(s).

Full Name*

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Account Number*

Account Number

Account Number

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If you have given your consent to have us authorize and pay overdrafts on ATM and everyday card transactions, you may revoke this consent at any time by forwarding a signed and dated request revoking your previous authorization to:

Deposit Operations, PO Box 10, Martins Ferry, OH 43935
If this is a joint account, any one of you may revoke the consent on behalf of the other account holder(s).