Partnership to Prevent Fake Check Scams and Other Frauds Participation Form Thank you for partnering with Consumer Federation of America to help educate consumers about fake check scams and similar frauds. Working together we can fight these scams more effectively and prevent victimization. By signing this form, you agree that your tellers will hand the CFA brochure about fake check scams and other frauds to consumers who come in to deposit checks or money orders for $1,000 or more or to withdraw $1,000 or more. You understand that it is not sufficient to simply put the brochures at the teller window, on a counter, or in a rack, though that may be done in addition to handing the brochures to consumers. You also understand that your tellers can use their judgment if specific circumstances lead them to believe that it is not appropriate to give the brochure to a consumer. Please fill out the information below. Your name and title: Your phone number: Your email address: Name of financial institution: Address: Shipping address for brochures if different: Number of brochures requested: Do you have an account with a shipping company to which the delivery cost can be billed? If so, please provide the information below, and thank you! X one: Federal Express
UPS
DHL
Other (provide name): Account number: Please sign (electronic signature is OK) and date this form and return to Susan Grant. Email to sgrant@consumerfed.org , fax to 202-265-7989, or mail to Susan Grant, CFA, 1620 Eye Street NW, Suite 200, W ashington, DC 20006. Signature:
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