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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]

[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-10(B) Applications and Solicitations Sample (Credit Cards)
Interest Rates and Interest Charges
Annual Percentage Rate
(APR) for Purchases

8.99% to 19.99% when you open your account, based on your creditworthiness.
After that, your APR will vary with the market based on the Prime Rate.

APR for Balance Transfers

15.99%
This APR will vary with the market based on the Prime Rate.

APR for Cash Advances

21.99%
This APR will vary with the market based on the Prime Rate.

Penalty APR and When it
Applies

28.99%
This APR may be applied to your account if you:
1) Make a late payment;
2) Go over your credit limit twice in a six-month period;
3) Make a payment that is returned; or
4) Do any of the above on another account that you have with us.
How Long Will the Penalty APR Apply?: If your APRs are increased for any of these
reasons, the Penalty APR will apply until you make six consecutive minimum payments
when due and do not exceed your credit limit during that time period.

How to Avoid Paying
Interest on Purchases

Your due date is at least 25 days after the close of each billing cycle. We will not charge
you interest on purchases if you pay your entire balance by the due date each month.

Minimum Interest Charge

If you are charged interest, the charge will be no less than $1.50.

For Credit Card Tips from
the Federal Reserve Board

To learn more about factors to consider when applying for or using a credit card, visit the
website of the Federal Reserve Board at http://www.federalreserve.gov/creditcard.

Fees
Annual Fee

None

Transaction Fees
 Balance Transfer

Either $5 or 3% of the amount of each transfer, whichever is greater (maximum fee: $100).

 Cash Advance

Either $5 or 3% of the amount of each cash advance, whichever is greater.

 Foreign Transaction

2% of each transaction in U.S. dollars.

Penalty Fees
 Late Payment

$29 if balance is less than or equal to $1,000;
$35 if balance is more than $1,000

 Over-the-Credit Limit

$29

 Returned Payment

$35

Other Fees
 Required Account

$0.79 per $100 of balance at the end of each statement period. See back for details.

Protector Plan
How We Will Calculate Your Balance: We use a method called "average daily balance (including new purchases).”

G-10(C) Applications and Solicitations (Credit Cards)
Interest Rates and Interest Charges
Annual Percentage Rate
(APR) for Purchases

8.99%, 10.99%, or 12.99% introductory APR for one year, based on your
creditworthiness.

After that, your APR will be
the Prime Rate.
APR for Balance Transfers

14.99%. This APR will vary with the market based on

15.99%
This APR will vary with the market based on the Prime Rate

APR for Cash Advances

21.99%
This APR will vary with the market based on the Prime Rate.

Penalty APR and When it
Applies

28.99%
This APR may be applied to your account if you:
1) Make a late payment;
2) Go over your credit limit;
3) Make a payment that is returned; or
4) Do any of the above on another account that you have with us.
How Long Will the Penalty APR Apply?: If your APRs are increased for any of these
reasons, we may keep them at this higher level indefinitely.

How to Avoid Paying
Interest on Purchases

Your due date is at least 25 days after the close of each billing cycle. We will not charge
you interest on purchases if you pay your entire balance by the due date each month.

Minimum Interest Charge

If you are charged interest, the charge will be no less than $1.50.

For Credit Card Tips from
the Federal Reserve Board

To learn more about factors to consider when applying for or using a credit card, visit the
website of the Federal Reserve Board at http://www.federalreserve.gov/creditcard.

Fees
Set-up and Maintenance
Fees

NOTICE: Some of these set-up and maintenance fees will be assessed before you begin
using your card and will reduce the amount of credit you initially have available. For
example, if you are assigned the minimum credit limit of $250, your initial available credit
will be only about $187 (or about $172 if you choose to have an additional card).

 Annual Fee

$30

 Account Set-up Fee

$30 (one-time fee)

 Participation Fee

$30 annually ($2.50 per month)

 Additional Card Fee

$15 annually (if applicable)

 Account Maintenance

$30 annually ($2.50 per month on closed accounts with an outstanding balance of $30 or
more)

Fee on Closed Accounts

Transaction Fees
 Balance Transfer

Either $5 or 3% of the amount of each transfer, whichever is greater (maximum fee: $100).

 Cash Advance

Either $5 or 3% of the amount of each cash advance, whichever is greater.

 Foreign Transaction

2% of each transaction in U.S. dollars.

Penalty Fees
 Late Payment

$29 if balance is less than or equal to $1,000;
$35 if balance is more than $1,000

 Over-the-Credit Limit

$29

 Returned Payment

$35

How We Will Calculate Your Balance: We use a method called "average daily balance (including new purchases).”
Loss of Introductory APR: We may end your introductory APR and apply the Penalty APR if you make a late
payment.

G-10(D) Applications and Solicitations Model Form (Charge Cards)
Payment Information
[A statement that charges incurred through use of the charge card are due when the periodic statement is received]

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]

G-10(E) Applications and Solicitations Sample (Charge Cards)
Payment Information
All charges made on this charge card are due and payable when you receive your periodic statement.

Fees
Annual Fee

$50

Transaction Fees
• Balance Transfer

Either $5 or 3% of the amount of each transfer, whichever is greater (maximum fee:
$100).

• Cash Advance

Either $5 or 3% of the amount of each cash advance, whichever is greater.

Penalty Fees
• Late Payment

$31 if balance is less than or equal to $1,000;
$35 if balance is more than $1,000

• Over-the-Credit Limit

$30

• Returned Payment

$30

G-17(A) Account-Opening Model Form
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]/[Paying Interest]

[Description of grace period for purchases, cash advances, balance transfers, or any
other credit extended or statement that no grace period applies]

[Minimum Interest
Charge]/[Minimum
Charge]

[Description of minimum interest charge or minimum charge, if applicable]

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]
[Notice of right to reject plan, 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]
Billing Rights: [Reference to account agreement for details on billing-error rights]

G-17(B) Account-Opening Sample
Interest Rates and Interest Charges
Annual Percentage Rate
(APR) for Purchases

8.99%
This APR will vary with the market based on the Prime Rate.

APR for Balance Transfers

15.99%
This APR will vary with the market based on the Prime Rate.

APR for Cash Advances

21.99%
This APR will vary with the market based on the Prime Rate.

Penalty APR and When it
Applies

28.99%
This APR may be applied to your account if you:
1) Make a late payment;
2) Go over your credit limit twice in a six-month period;
3) Make a payment that is returned; or
4) Do any of the above on another account that you have with us.
How Long Will the Penalty APR Apply?: If your APRs are increased for any of these
reasons, the Penalty APR will apply until you make six consecutive minimum payments
when due and do not exceed your credit limit during that time period.

Paying Interest

Your due date is at least 25 days after the close of each billing cycle. We will not charge
you interest on purchases if you pay your entire balance by the due date each month. We
will begin charging interest on cash advances and balance transfers on the transaction
date.

Minimum Interest Charge

If you are charged interest, the charge will be no less than $1.50.

For Credit Card Tips from
the Federal Reserve Board

To learn more about factors to consider when applying for or using a credit card, visit the
website of the Federal Reserve Board at http://www.federalreserve.gov/creditcard.

Fees
Annual Fee

None

Transaction Fees
 Balance Transfer

Either $5 or 3% of the amount of each transfer, whichever is greater (maximum fee: $100).

 Cash Advance

Either $5 or 3% of the amount of each cash advance, whichever is greater.

 Foreign Transaction

2% of each transaction in U.S. dollars.

Penalty Fees
 Late Payment

$29 if balance is less than or equal to $1,000;
$35 if balance is more than $1,000

 Over-the-Credit Limit

$29

 Returned Payment

$35

Other Fees
 Required Account

Protector Plan

$0.79 per $100 of balance at the end of each statement period. See back for details.

How We Will Calculate Your Balance: We use a method called "average daily balance (including new purchases).”
See your account agreement for more details.
Billing Rights: Information on your rights to dispute transactions and how to exercise those rights is provided in your
account agreement.

G-17(C) Account-Opening Sample
Interest Rates and Interest Charges
Annual Percentage Rate
(APR) for Purchases

8.99% introductory APR for one year.
After that, your APR will be 14.99%. This APR will vary with the market based on
the Prime Rate.

APR for Balance Transfers

15.99%
This APR will vary with the market based on the Prime Rate.

APR for Cash Advances

21.99%
This APR will vary with the market based on the Prime Rate.

Penalty APR and When it
Applies

28.99%
This APR may be applied to your account if you:
1) Make a late payment;
2) Go over your credit limit;
3) Make a payment that is returned; or
4) Do any of the above on another account that you have with us.
How Long Will the Penalty APR Apply?: If your APRs are increased for any of these
reasons, we may keep them at this higher level indefinitely.

Paying Interest

Your due date is at least 25 days after the close of each billing cycle. We will not charge
you interest on purchases if you pay your entire balance by the due date each month. We
will begin charging interest on cash advances and balance transfers on the transaction
date.

Minimum Interest Charge

If you are charged interest, the charge will be no less than $1.50.

For Credit Card Tips from
the Federal Reserve Board

To learn more about factors to consider when applying for or using a credit card, visit the
website of the Federal Reserve Board at http://www.federalreserve.gov/creditcard.

Fees
Set-up and Maintenance
Fees

NOTICE: Some of these set-up and maintenance fees will be assessed before you begin
using your card and will reduce the amount of credit you initially have available. Based on
your initial credit limit of $250, your initial available credit will be only about $187 (or about
$172 if you choose to have an additional card).
You may still reject this plan, provided that you have not yet used the account or paid a fee
after receiving a billing statement. If you do reject the plan, you are not responsible for any
fees or charges.

 Annual Fee

$30

 Account Set-up Fee

$30 (one-time fee)

 Participation Fee

$30 annually ($2.50 per month)

 Additional Card Fee

$15 annually (if applicable)

 Account Maintenance

$30 annually ($2.50 per month on closed accounts with an outstanding balance of $30 or
more)

Fee on Closed Accounts

Transaction Fees
 Balance Transfer

Either $5 or 3% of the amount of each transfer, whichever is greater (maximum fee: $100).

 Cash Advance

Either $5 or 3% of the amount of each cash advance, whichever is greater.

 Foreign Transaction

2% of each transaction in U.S. dollars.

Penalty Fees
 Late Payment

$29 if balance is less than or equal to $1,000;
$35 if balance is more than $1,000

 Over-the-Credit Limit

$29

 Returned Payment

$35

How We Will Calculate Your Balance: We use a method called "average daily balance (including new purchases).”
See your account agreement for more details.
Loss of Introductory APR: We may end your introductory APR and apply the Penalty APR if you make a late payment.
Billing Rights: Information on your rights to dispute transactions and how to exercise those rights is provided in your
account agreement.

G-17(D) Account-Opening Sample (Line of Credit)
Interest Rate and Interest Charges
APR for Cash Advances

18.00%.

Minimum Interest Charge

If you are charged interest, the charge will be no less than $1.50.

Paying Interest

You will be charged interest from the transaction date.

Fees
Annual Fee

$20

Penalty Fees
 Late Payment

$10

 Over-the-Credit Limit

$29

How We Will Calculate Your Balance: We use a method called “average daily balance (including new purchases).” See
your account agreement for more details.
Billing Rights: Information on your rights to dispute transactions and how to exercise those rights is provided in your
account agreement.

G-18(A) Periodic Statement Transactions; Interest Char2es; Fees Sample
Transactions
Reference Number
5884186PS0388W6YM
0544400060ZLV72VL
854338203FS8000Z5
55541860705RDYDOX
554328608008VV90MO
054830709LYM RPT 4L
564891561545KOSHD
841517877845AKOJ10
895848561561894KOH
1871556189456SAMKL
1542202074TWWZV48
2564894185189LKDFID
4545754784KOHUIOS

Trans Date
2/22
2/24
2/25
2/25
2/25
2/25
2/25
2/25
2/26
2/26
2/26
2/27
2/27

Post Date
2/23
2/25
2/25
2/26
2/26
2/26
2/26
2/26
2/27
2/27
2/26
2/28
3/1

Description of Transaction or Credit
Store #1
Store #2
Pymt Thank You
Store #3
Store #4
Store #5
Store #6
Store #7
Store #8
Store #9
Cash Advance
Store #10

Amount
$2.05
$12.11
$450.00­
$4.63
$114.95
$7.35
$14.35
$40.35
$27.68
$124.76
$121.50
$32.87

2564561023184102315

2/28

3/1

Store #11

14547847586KDDL564

2/28

2/28

Cash Advance

55542818705RASDOX

3/1

3/2

Store #12

$3.76

289189194ASDS8744

3/1

3/3

Store #13

$13.45

$785.00

Balance Transfer

$14.76
$196.50

178105417841045784

3/2

3/4

Store #14

$2.35

045148714518979874

3/4

3/5

Store #13

$13.45­

8456152156181SDSA

3/5

3/6

Store #15

$25.00

31289105205648AWD

3/11

3/12

Store #16

$7.34

04518478415615ASD

3/11

3/16

Store #17

$10.56

0547810544898718AF

3/15

3/17

Store #18

$24.50

05648941 32168480 P

3/16

3/17

Store #19

$8.76

054894561564ASDW

3/17

3/18

Store #20

$14.23

5648974891AD98156

3/19

3/20

Store #21

$23.76
$35.00

Fees

I
9525156489SFD4545Q

2/23

2/23

Late Fee

564156156470JSNDS

2/26

2/26

Cash Advance Fee

84151564SADS8745H

2/27

2/27

Balance Transfer Fee

256489156189451516L

2/28

2/28

$5.00
$23.55

Cash Advance Fee

$5.90

TOTAL FEES FOR THIS PERIOD

$69.45

Interest Charged

Interest Charge on Purchases
Interest Charge on Cash Advances
TOTAL INTEREST FOR THIS PERIOD

2012 Totals Year-to-Date

Total fees charged in 2012

$90.14

Total interest charged in 2012

$18.27

$6.31
$4.58
$10.89

G-18(D) Periodic Statement New Balance, Due Date, Late Payment and
Minimum Payment Sample (Credit Cards)
Payment Information
New Balance

$1,784.53

Minimum Payment Due

$48.00

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 each period, you will pay more in interest and it will
take you longer to pay off your balance. For example, if you
had a balance of $1,000 at an interest rate of 17% and
always paid only the minimum required, it would take over 7
years to repay this balance. For an estimate of the time it
would take to repay your actual balance making only
minimum payments, call 1-800-XXX-XXXX.

G-18(E) Periodic Statement New Balance, Due Date and
Late Payment Sample (Open-End Plans (Non-credit-card Accounts))
Payment Information
New Balance

$1,784.53

Minimum Payment Due

$48.00

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%.

G-18(F) 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

$535.07
-$450.00
-$13.45
+$529.57
+$785.00
+$318.00
+$0.00
+$69.45
+$10.89

New Balance

$1,784.53

Credit limit
Available credit
Statement closing date
Days in billing cycle

$2,000.00
$215.47
3/22/2012
30

QUESTIONS?
Call Customer Service
Lost or Stolen Credit Card

New Balance

$1,784.53

Minimum Payment Due

$48.00

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 each period, you will pay more in interest
and it will take you longer to pay off your balance. For example,
if you had a balance of $1,000 at an interest rate of 17%
and always paid only the minimum required, it would take
over 7 years to repay this balance. For an estimate of the
time it would take to repay your actual balance making only
minimum payments, call 1-800-XXX-XXXX.
Please send billing inquiries and correspondence to:
PO Box XXXX, Anytown, Anystate XXXXX

1-XXX-XXX-XXXX
1-XXX-XXX-XXXX

Important Changes to Your Account Terms
The following is a summary of changes that are being made to your account terms. You have the right to opt out of these
changes. For more detailed information, please refer to the booklet enclosed with this statement.
These changes will impact your account as follows:
Transactions made on or after 4/2/12: As of 5/10/12, any changes to APRs described below will apply to these
transactions.
Transactions made before 4/2/12: Current APRs will continue to apply to these transactions.
If you are already being charged a higher Penalty APR for purchases: In this case, any changes to APRs described below
will not go into effect at this time. These changes will go into effect when the Penalty APR no longer applies to your
account.

APR for Purchases
Late Payment Fee

Revised Terms, as of 5/10/12
16.99%
$32 if your balance is less than or equal to $1,000;
$39 if your balance is more than $1,000

Transactions
Reference Number
5884186PS0388W6YM
0544400060ZLV72VL
55541860705RDYD0X
554328608008W90M0
054830709LYMRPT4L
854338203FS8OO0Z5

Trans Date
2/22
2/24
2/24
2/24
2/24
2/25

Post Date
2/23
2/25
2/25
2/25
2/25
2/25

Description of Transaction or Credit
Store #1
Store #2
Store #3
Store #4
Store #5
Pymt Thank You

Amount
$2.05
$12.11
$4.63
$114.95
$7.35
$450.00–

(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

$1,784.53

Minimum Payment Due

$48.00

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
564891561545KOSHD
841517877845AKOJIO
895848561561894KOH
1871556189456SAMKL
1542202074TWWZV48
2564894185189LKDFID
4545754784KOHUIOS
14547847586KDDL564
2564561023184102315
55542818705RASD0X
289189194ASDS8744
178105417841045784
045148714518979874
8456152156181SDSA
31289105205648AWD
04518478415615ASD
0547810544898718AF
056489413216848OP
054894561564ASDW
5648974891AD98156

Trans Date
2/25
2/25
2/26
2/26
2/26
2/27
2/27
2/28
2/28
3/1
3/1
3/2
3/4
3/5
3/11
3/11
3/15
3/16
3/17
3/19

9525156489SFD4545Q
56415615647OJSNDS
84151564SADS8745H
256489156189451516L

2/23
2/26
2/27
2/28

Post Date
Description of Transaction or Credit
2/26
Store #6
2/26
Store #7
2/27
Store #8
2/27
Store #9
2/26
Cash Advance
2/28
Store #10
3/1
Balance Transfer
2/28
Cash Advance
3/1
Store #11
3/2
Store #12
3/3
Store #13
3/6
Store #14
3/5
Store #13
3/12
Store #15
3/12
Store #16
3/16
Store #17
3/17
Store #18
3/17
Store #19
3/18
Store #20
3/20
Store #21
Fees
2/23
Late Fee
2/26
Cash Advance Fee
2/27
Balance Transfer Fee
2/28
Cash Advance Fee
TOTAL FEES FOR THIS PERIOD
Interest Charged
Interest Charge on Purchases
Interest Charge on Cash Advances
TOTAL INTEREST FOR THIS PERIOD

Amount
$14.35
$40.35
$27.68
$124.76
$121.50
$32.87
$785.00
$196.50
$14.76
$3.76
$13.45
$2.35
$13.45–
$25.00
$7.34
$10.56
$24.50
$8.76
$14.23
$23.76
$35.00
$5.00
$23.55
$5.90
$69.45
$6.31
$4.58
$10.89

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

Interest Charge

Purchases

14.99% (v)

$512.14

$6.31

Cash Advances

21.99% (v)

$253.50

$4.58

$637.50

$0.00

Type of Balance

Balance Transfers
(v) = Variable Rate

0.00%

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

QUESTIONS?
Call Customer Service
Lost or Stolen Credit Card

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 of28.99%.
Minimum Payment Warning: If you make only the minimum
payment each month, it will take you about 13 months to
repay the balance shown on this statement.
Please send billing inquiries and correspondence to:
PO Box XXXX, Any town, Anystate XXXXX

1-XXX-XXX-XXXX
1-XXX-XXX-XXXX

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 5/1 0/12, the Penalty APR will apply to these transactions. We may keep the
APR at this level indefinitely.
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 transactions as well.

Transactions
Reference Number

Trans Date

854338203FS8000Z5

2/25

5884186PS0388W6YM
0544400060ZLV72VL
55541860705RDYDOX
554328608008W90MO
054830709 LYM RPT4L
564891561545KOSHD
841517877845AKOJIO
895848561561894KOH
1871556189456SAMKL
2564894185189LKDFID
55542818705RASDOX
178105417841045784
8456152156181 SDSA

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 of2

Please detach this portion and return Vvith 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

AMOUNTENCLOSED:~I$_ _________________~

xxx Bank
P.O. Box XXXX
Anytown, Anystate XXXXX

dd dlid lid Ilid IllId ddlllliid 1IIIIId dlllilid lid I
1111 dIlIlId IdIlid lid III d1IIIIIIIIIIIIdddd 111111111

Page 2 of 2

XXX Bank Credit Card Account Statement
Account Number XXXX XXXX XXXX XXXX
February 21, 2012 to March 22, 2012

Transactions (cont.)
Reference Number

Trans Date

9525156489SFD4545Q
564156156470JSNDS

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

Interest Charge

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%

G-19 Checks Accessing a Credit Card Sample

Interest and Fee Information
APR for Check
Transactions

1.7% (Promotional APR through your November 2012 billing cycle)
After November 2012, you will be charged the APR for Cash Advances, currently
21.99%.

Use by Date

You must use the check by 4/1/12 for the promotional APR to apply. If you use the
check after that date, we may still honor the check but you will not receive the
promotional APR. Instead, the standard APR for Cash Advances will apply.

Fee

Either $5 or 3% of the amount of each transaction, whichever is greater.

Paying Interest

We will begin charging interest on these checks on the transaction date.

G-20 Change-in-Terms Sample
Important Changes to Your Account Terms
The following is a summary of changes that are being made to your account terms. You have the right to opt out of these
changes. For more detailed information, please refer to the booklet enclosed with this statement.
These changes will impact your account as follows:
Transactions made on or after 4/2/12: As of 5/10/12, any changes to APRs described below will apply to these
transactions.
Transactions made before 4/2/12: Current APRs will continue to apply to these transactions.
If you are already being charged a higher Penalty APR for purchases: In this case, any changes to APRs described below
will not go into effect at this time. These changes will go into effect when the Penalty APR no longer applies to your
account.

APR for Purchases
Late Payment Fee

Revised Terms, as of 5/10/12
16.99%
$32 if your balance is less than or equal to $1,000;
$39 if your balance is more than $1,000

G-21 Penalty Rate Increase Sample
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. We may keep the
APR at this level indefinitely.
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 transactions as well.