Dd Form 2887 - Navy/marine And Eagle Cash Enrollment And Authorization Agreement (Page 2 of 2) in pdf

NAVY/MARINE AND EAGLE CASH ENROLLMENT AND AUTHORIZATION AGREEMENT

PRIVACY ACT STATEMENT

AUTHORITY: Executive Order 9379, Department of Defense Financial Management Regulation (DoDFMR) 7000.14-R, Vol. 5,

Disbursing Policy and Procedures, and 31 CFR 210.

PRINCIPAL PURPOSE(S): To enroll individuals in the Navy/Marine Cash or Eagle Cash programs. Aggregate data about

transactions captured both on and off the ship, whether on the card's electronic purse or through the magnetic strip may be

used to generate summary level reports.

ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. Section 552(a)(b) of

the Privacy Act of 1974, as amended. It may also be disclosed outside of the Department of Defense to the U.S. Treasury

Department, Fiscal and Financial Agents involved in providing Navy/Marine or Eagle Cash services, and their contractors. In

addition, other Federal, State, or local government agencies, which have identified a need to know, may obtain this

information for the purpose(s) identified in the DoD Blanket Routine Uses as published in the Federal Register.

DISCLOSURE: Disclosure is voluntary; however, failure to furnish the requested information may prevent you from

participating in the Navy/Marine or Eagle Cash programs.

1. RATE, RANK, TITLE

2. FIRST NAME

3. MIDDLE INITIAL 4. LAST NAME

5. SSN

6. PAY GRADE 7. MILITARY BRANCH

8. DATE OF

9. MOTHER'S MAIDEN NAME

(Organization)

BIRTH (MMDD)

10. ADDRESS 1 (Ship's/Organization's Name)

11. ADDRESS 2 (Division/Unit, etc.)

12. CITY

13. STATE

14. ZIP CODE

15. COUNTRY

16. WORK TELEPHONE NUMBER

17. E-MAIL ADDRESS

AUTHORIZATION TO MAKE NAVY/MARINE, OR EAGLE CASH TRANSFERS ELECTRONICALLY TO AND FROM MY BANK OR

CREDIT UNION ACCOUNT

I authorize the U.S. Treasury's Financial Agent to initiate debit and credit entries to my bank or credit union account at the

financial institution named below in order to fulfill any requests I may make to transfer funds between my bank or credit union

account and my Navy/Marine or Eagle Cash account.

18. DEPOSITORY NAME

19. BRANCH

20. CITY

21. STATE

22. ZIP CODE

23. ABA ROUTING NUMBER

24. ACCOUNT NUMBER

25. ACCOUNT NAME (Your name as it appears on your account)

26. ACCOUNT TYPE (C = Checking,

S = Savings)

This authorization will remain in effect until you notify the applicable Department of Defense Agency in writing of its

cancellation.

In consideration of the privilege of having the U.S. Treasury initiate debit and credit transactions to my bank or credit union

account specified above, I hereby freely and voluntarily consent to the immediate collection from my pay by the U.S. Navy,

Marine Corps or Army, without prior notice or prior opportunity to be heard, the face value or resulting negative account

balance due the U.S. Treasury funds pool of any funds which were transferred to my Navy/Marine or Eagle Cash account, plus

any additional fees levied by a financial institution, when such funds were not collectible from my specified bank or credit

union account because a transaction is dishonored and returned for insufficient funds, closed account, inaccurate account

information, or any other return reason.

27. SIGNATURE

28. DATE SIGNED (YYYYMMMDD)

DD FORM 2887, DEC 2004

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Dd Form 2887 - Navy/marine And Eagle Cash Enrollment And Authorization Agreement Page 2

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