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G-10(A) Applications and Solicitations Model Form (Credit Cards) Interest Rates and Interest Charges Annual Percentage Rate (APR) for Purchases [Purchase rate] [Description that rate varies and how it is determined, if applicable] APR for Balance Transfers [Balance transfer rate] [Description that rate varies and how it is determined, if applicable] APR for Cash Advances [Cash advance rate] [Description that rate varies and how it is determined, if applicable] Penalty APR and When it Applies [Penalty rate] [Description of events that may result in the penalty rate] [Description of how long penalty rate may apply] [How to Avoid Paying Interest on Purchases/ Paying Interest] [Description of grace period for purchases or statement that no grace period applies] [Minimum Interest Charge]/[Minimum Charge] [Description of minimum interest charge or minimum charge] For Credit Card Tips from the Federal Reserve Board [Reference to Board’s website] Fees [Annual Fee]/[Set-up and Maintenance Fees] [Notice of available credit, if applicable] [Description of fees for availability or issuance of credit, such as an annual fee, if applicable] Transaction Fees Balance Transfer [Description of balance transfer fee] Cash Advance [Description of cash advance fee] Foreign Transaction [Description of foreign transaction fee] Penalty Fees Late Payment [Description of late payment fee] Over-the-Credit Limit [Description of over-the-credit limit fee] Returned Payment [Description of returned payment fee] Other Fees Required [insert name of required insurance, or debt cancellation or suspension coverage] [Description of cost of insurance, or debt cancellation or suspension plans] [Cross reference to additional information, if applicable] How We Will Calculate Your Balance: [Description of balance computation method] Loss of Introductory APR: [Circumstances in which introductory rate may be revoked and rate that applies if introductory rate is revoked, if applicable] [Description that rate that applies after introductory rate is revoked varies and how it is determined, if applicable] G-18(G) Periodic Statement Form Page 1 of 2 XXX Bank Credit Card Account Statement Account Number XXXX XXXX XXXX XXXX February 21, 2012 to March 22, 2012 Payment Information Summary of Account Activity Previous Balance Payments Other Credits Purchases Balance Transfers Cash Advances Past Due Amount Fees Charged Interest Charged $80.52 -$50.00 +$0.00 +$52.13 +$0.00 +$0.00 +$0.00 +$37.00 +$0.00 New Balance $119.65 Credit limit Available credit Statement closing date Days in billing cycle $2,000.00 $1,880.35 3/22/2012 30 New Balance $119.65 Minimum Payment Due $10.00 Payment Due Date 4/20/12 Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a $35 late fee and your APRs may be increased up to the Penalty APR of 28.99%. Minimum Payment Warning: If you make only the minimum payment on time each month and no other amounts are added to the balance, we estimate that it will take you approximately 13 months to pay off the balance shown on this statement. Please send billing inquiries and correspondence to: PO Box XXXX, Anytown, Anystate XXXXX QUESTIONS? Call Customer Service 1-XXX-XXX-XXXX L Notice of Changes to Your Interest Rates You have triggered the Penalty APR of 28.99%. This change will impact your account as follows: Transactions made on or after 4/2/12: As of 5/10/12, the Penalty APR will apply to these transactions. W Transactions made before 4/2/12: Current rates will continue to apply to these transactions. However, if you become more than 30 days late on your account, the Penalty APR will apply to those balances as well. Transactions Reference Number Trans Date 854338203FS8OO0z5 2/25 5884186PS0388w6YM 0544400060zlV72Vl 55541860705RDYD0X 554328608008w90M0 054830709lYMRPT4l 564891561545KOSHD 841517877845AKOJIO 895848561561894KOH 1871556189456SAMKl 2564894185189lKDFID 55542818705RASD0X 178105417841045784 8456152156181SDSA 2/22 2/24 2/24 2/24 2/24 2/25 2/25 2/26 2/26 2/27 3/1 3/2 3/5 Post Date Description of Transaction or Credit Payments and Other Credits 2/25 Pymt Thank You Purchases 2/23 Store #1 2/25 Store #2 2/25 Store #3 2/25 Store #4 2/25 Store #5 2/26 Store #6 2/26 Store #7 2/27 Store #8 2/27 Store #9 2/28 Store #10 3/2 Store #11 3/6 Store #12 3/12 Store #13 Amount $50.00– $2.05 $2.11 $4.63 $4.95 $7.35 $4.35 $2.35 $7.68 $4.76 $2.87 $3.76 $2.35 $2.92 (transactions continued on next page) NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Page 1 of 2 Please detach this portion and return with your payment to insure proper credit. Retain upper portion for your records. Please indicate address change and additional cardholder requests on the reverse side. Account Number: XXXX XXXX XXXX XXXX New Balance $119.65 Minimum Payment Due $10.00 Payment Due Date 4/20/12 AMOUNT ENCLOSED: $ XXX Bank P.O. Box XXXX Anytown, Anystate XXXXX l l l l ll lll llll ll ll llllll ll llll llll ll llll llll lllll l l l lll lll lll ll ll ll ll l l l ll l lll llll ll ll ll lll llll ll ll l lllll l lll lll ll l ll llll XXX Bank Credit Card Account Statement Account Number XXXX XXXX XXXX XXXX February 21, 2012 to March 22, 2012 Page 2 of 2 Transactions (cont.) Reference Number Trans Date 9525156489SFD4545Q 56415615647OJSNDS 2/23 3/22 Post Date Description of Transaction or Credit Fees 2/23 late Fee 3/22 Minimum Charge TOTAL FEES FOR THIS PERIOD Interest Charged Interest Charge on Purchases Interest Charge on Cash Advances TOTAL INTEREST FOR THIS PERIOD Amount $35.00 $2.00 $37.00 $0.00 $0.00 $0.00 2012 Totals Year-to-Date Total fees charged in 2012 $90.14 Total interest charged in 2012 $18.27 Interest Charge Calculation Your Annual Percentage Rate (APR) is the annual interest rate on your account. Annual Percentage Rate (APR) Balance Subject to Interest Rate Purchases 14.99% (v) $113.80 $0.00 Cash Advances 21.99% (v) $0.00 $0.00 $0.00 $0.00 Type of Balance Balance Transfers (v) = Variable Rate 0.00% Interest Charge