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Balance Transfer

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I (We) request that Patent and Trademark Office Federal Credit Union make payment(s) to the payee(s) in the amount(s) designated below. I have enclosed the statement and payment envelopes for the accounts listed below. I (We) understand that this is my (our) responsibility to pay the payee(s) according to the payee's normal payment schedule and I (we) will be responsible for any late payment charges. I (we) also understand that the total payoff amount on these cards cannot exceed my (our) available line of credit. A 25-day grace period applies to all balance transfers.

Name:

Member Number:

Email Address:

Visa Credit Card #:

Exp. Date:

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Payee:

Amount:

Account Number:

Street Address:

Street Address 2:

City:

State:

ZIP:

Payee:

Amount:

Account Number:

Address:

Address 2:

City:

State:

ZIP:

Payee:

Amount:

Account Number:

Address:

Address 2:

City:

State:

ZIP:

Security Code:

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Balance Transfer