The written authorization form provided to a customer by a financial institution must contain: (1) a signature bar for the customer's signature; and (2) a provision in uppercase, bold-faced type that is substantially similar to this provision and in at least 12-point font: THE STATE OF TEXAS HAS ESTABLISHED AN ELECTRONIC NOTIFICATION SYSTEM TO DELIVER INFORMATION TO CHECK VERIFICATION ENTITIES REGARDING VICTIMS OF OFFENSES UNDER SECTION 32.51, PENAL CODE, REGARDING FRAUDULENT USE OR POSSESSION OF IDENTIFYING INFORMATION OF A PERSON. THE CHECK VERIFICATION ENTITIES USE INFORMATION RECEIVED TO ASSIST BUSINESSES IN DECIDING WHETHER TO ACCEPT CHECKS AND OTHER PAYMENT DEVICES PRESENTED TO THEM. BY SUBMITTING THIS FORM, YOU ARE AUTHORIZING _______________________ (NAME OF FINANCIAL INSTITUTION) TO SUBMIT THE INFORMATION YOU PROVIDED ON THE SWORN STATEMENT TO THE ELECTRONIC NOTIFICATION SYSTEM. |
