Credit Card Payment Form (And Instructions)
Credit Card Payment Form (And Instructions) Form. This is a Official Federal Forms form and can be use in Patent US Patent Office.
Tags: Credit Card Payment Form (And Instructions), PTO-2038, Official Federal Forms US Patent Office, Patent
United States Patent and Trademark Office Instructions for Completing the Credit Card Payment Form Credit Card Information Enter all credit card information including the payment amount to be charged to your credit card and remember to sign the form. The United States Patent and Trademark Office (USPTO) cannot process credit card payments without an authorized signature. The USPTO does not accept a general authorization to charge any payment deficiency or any additional fees to a credit card. The USPTO does not accept debit cards or check cards that require use of a personal identification number as a method of payment. Credit Card Billing Address Address information is required for credit card payment as a means of verification. Failure to complete the address information, including zip/postal code, may result in the payment not being accepted by your credit card institution. Request and Payment Information Provide a description of your request based on the payment amount. For example, indicate the item as “basic filing fee” (patent) or “first maintenance fee” (patent maintenance fee) or “application for registration” (trademark) or “certified copy of a patent” (other fee). Indicate the nature of your request by the type of fee you wish to pay: Patent Fee, Patent Maintenance Fee, Trademark Fee or Other Fee. Complete information for each type of fee as applicable to identify the nature of your request. Indicate only one type of fee per form. If you are requesting and paying a fee based on a previously filed patent or trademark application, indicate the application/serial number, patent number or registration number that is associated with your request. “Other Fee” is used to request copies of patent and trademark documents, certified copies, assignments, and other information products. IDON numbers are assigned by the USPTO for customers ordering patent and trademark information and products specified as “Other Fee” on the order form. If you have been assigned an IDON number from a previous customer order, include it with your request. For more information on USPTO fees and amounts, refer to the current fee schedule at www.uspto.gov (click on the “Site Index” link, “Fees, USPTO” link). To request a copy by mail, call the USPTO Contact Center at (800) 786-9199 or (571) 272-1000. Information on mailing addresses is also available at www.uspto.gov (click on the “Site Index” link, “Mailing Addresses” link). Protect Your Credit Card Information The USPTO strongly recommends using this form for credit card payments submitted by mail, facsimile, or by hand-delivery. To protect your credit card information use only this form and do not include credit card information on any other form or document. To protect your credit card information, do not submit this form electronically through “EFS-Web” or any other USPTO Internet site. Credit card information for electronic credit card payments should be entered exclusively on the USPTO Internet site providing electronic payment capability. American LegalNet, Inc. www.FormsWorkflow.com United States Patent and Trademark Office Instructions for Completing the Credit Card Payment Form Paperwork Reduction Act Statement This Credit Card Payment Form (PTO-2038) is approved for use through 12/31/2011 under OMB Control Number 06510043. This collection of information is required by 15 U.S.C. § 1113 or 35 U.S.C. § 41 and 37 CFR 1.16-1.28, 1.492, or 2.6-2.7. The information must be provided by a member of the public if he or she chooses to pay a USPTO fee by credit card. This information is also used by the USPTO to charge the appropriate fee amount to the appropriate credit card account. This collection is estimated to take two minutes to complete, including gathering and preparing information and submitting the Credit Card Payment Form (PTO-2038) to the USPTO. Time will vary depending upon the individual case. Please send any comments on the amount of time required to complete this form and/or suggestions for reducing the time burden to the Chief Information Officer, USPTO, PO Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. PLEASE REFER TO THE USPTO WEB SITE, UNDER THE “SITE INDEX” LINK, “MAILING ADDRESSES” LINK FOR THE CORRECT MAILING ADDRESS. Privacy Act Advisory Statement The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with the request for information solicited on the Credit Card Payment Form (PTO-2038). Accordingly, pursuant to the requirements of the Act, please be advised that: (1) the authority for the collection of this information is 15 U.S.C. § 1113 or 35 U.S.C. § 41 and 37 CFR 1.16-1.28, 1.492, or 2.6-2.7; (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which the information is used by the USPTO is to charge the appropriate fee amount to the appropriate credit card account. If you do not furnish the requested information, the USPTO may not be able to charge the fee to the credit card or the credit card institution may refuse to accept the charge, either of which will result in the fee being treated as not having been paid. The information provided by you in this form will be subject to the following routine uses: (1) The information on this form will be treated confidentially to the extent allowed under the Freedom of Information Act (5 U.S.C. § 552) and the Privacy Act (5 U.S.C. § 552(a)). Records from this system of records may be disclosed to the Department of Justice to determine whether disclosure of these records is required by the Freedom of Information Act. (2) A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a court, magistrate or administrative tribunal, including disclosures to opposing counsel in the course of settlement negotiations. (3) A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a request involving an individual when the individual has requested assistance from the Member with respect to the subject matter of the record. (4) A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency having need for the information in order to perform the contract. Recipients of information shall be required to comply with the requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S.C. §552a(m). (5) A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services Administration (GSA), or his designee, during an inspection of records conducted by GSA as part of that agency’s responsibility to recommend improvements in records management practices and programs, under authority of 44 U.S.C. § 2904 and § 2906. Such disclosure shall be made in accordance with the GSA regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make determinations about individuals. American LegalNet, Inc. www.FormsWorkflow.com PTO-2038 (09-2006) Approved for use through 12/31/2011. OMB 0651-0043 United States Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. Credit Card Payment Form (Do not submit this form electronically via EFS-Web) Please Read Instructions before Completing this Form Credit Card Information Credit Card Type: Visa MasterCard American Express Discover Credit Card Account #: Credit Card Expiration Date: Name as it Appears on Credit Card: Payment Amount: $ (US Dollars): Cardholder Signature: Date: Refund Policy: The USPTO may refund a fee paid by mistake or in excess of that required. A change of purpose after the payment of a fee will not entitle a party to a refund of such fee. The USPTO will not refund amounts of $25.00 or less unless a refund is specifically requested and will not notify the payor of such amounts (37 CFR 1.26). Refund of a fee paid by credit card will be issued as a credit to the credit card account to which the fee was charged. Service Charge: There is a $50.00 service charge for processing each payment refused (including a check returned "unpaid") or charged back by a financial institution (37 CFR 1.21 (m)) . Credit Card Billing Address Street Address 1: Street Address 2: City: State/Province: Zip/Postal Code: Country: Daytime Phone #: Fax #: Request and Payment Information Description of Request and Payment Information: Patent Fee Patent Maintenance Fee Trademark Fee Other Fee Application No. Application No. Application No. IDON Customer No. Patent No. Patent No. Registration No. Attorney Docket No. Identify or Describe Mark If the cardholder includes a credit card number on any form or document other than the Credit Card Payment Form or submits this form electronically via EFS-Web, the United States Patent and Trademark Office will not be liable in the event that the credit card number becomes public knowledge. American LegalNet, Inc. www.FormsWorkflow.com