By signing below, I hereby authorize NeuBridg, Inc. and/or my Employer to act as my agent to submit my application for the Payment Card to the issuing Financial Institution of the Payment card, and to the Terms and Conditions governing my use of Payment Card that I will receive at the time I receive my card. I understand that I am solely liable for the Payment Cards initial issuance fee charged by NeuBridg, Inc., as shown on the NeuBridg Fee Schedule at the time of this application. I understand that it is my responsibility to review the applicable NeuBridg Fee Schedule for applicable fees. I understand that this authorization replaces any previous authorization relating to NeuBridg, Inc or my employer’s payment to me, and unless terminated by NeuBridg, Inc., my Employer, or the issuing Financial Institution, this authorization will remain in full force and effect until NeuBridg, Inc. has received written notification from me of its termination in such time as to afford it a reasonable opportunity to act, or I have terminated the Payment Card as provided in the Terms and Conditions I received with the card. Upon approval of my application for the Payment Card, I hereby authorize NeuBridg, Inc. and/or my employer to deposit payments due to me to my Payment Card and perform the following actions or corrective actions related to my payment card: 1) Deduct the initial issuance fee from my NeuBridg, Inc. account; 2)correct any funding errors made by NeuBridg, Inc. and/or my Employer to which I am not entitled by submitting a correcting debit to my pay card account through ACH or directly to my pay card account; 3) At my request, submit a request for a change in my pay card account status to lost or stolen (or effectuate a change in the employee’s account status to lost or stolen); 4) At my request transfer funds to a newly issued card; This Consent does not allow my Employer to access my cardholder activity detail on my Payment Card without my prior consent. The USA PATRIOT Act is a federal law that requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. You will be asked to provide your name, a valid physical U.S. street address, a telephone number, date of birth, and other information that will allow us to identify you. You may also be asked to provide documentation as proof of identification. I acknowledge and agree that this authorization may be rejected or discontinued by the issuing Financial Institution at any time. After exhausting all opportunities to provide the applicant a payment card, if the applicant is ultimately denied receipt of the Payment Card, NeuBridg will provide eligible SUB Distributions to the employee by check which is sent to the employer's corporate address.