Extended Coverage Consent Form
I DO NOT want Heartland Credit Union to authorize and pay overdrafts on my everyday debit card transactions.
Opt Out
I WANT Heartland Credit Union to authorize and pay overdrafts on my everyday debit card transactions.
Opt In
Name
*
First Name
Last Name
Email
*
example@example.com
Member Number
*
List additional accounts you would like your decision to apply to.
Signature
Submit
Should be Empty: