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  3. Regulation E
  4. APPENDIX A
  5. A-8
6-355

A-8—Model Clause for Electronic Collection of Returned-Item Fees (§ 205.3(b)(3))

If your payment is returned unpaid, you authorize [us / name of person collecting the fee electronically] to make a one-time electronic fund transfer from your account to collect a fee of [$ 
]. [If your payment is returned unpaid, you authorize [us / name of person collecting the fee electronically] to make a one-time electronic fund transfer from your account to collect a fee. The fee will be determined [by] / [as follows]: [ 
].]
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