Credit Card Payment To The International Bureau As Receiving Office
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Credit Card Payment To The International Bureau As Receiving Office Form. This is a Official Federal Forms form and can be use in PCT US Patent Office.
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Tags: Credit Card Payment To The International Bureau As Receiving Office, PCT-RO-197, Official Federal Forms US Patent Office, PCT
PATENT COOPERATION TREATY
PCT
To:
CREDIT CARD PAYMENT
TO THE INTERNATIONAL BUREAU
AS RECEIVING OFFICE
The International Bureau of WIPO
PCT Receiving and Processing Team
34, chemin des Colombettes
1211 Geneva 20
Switzerland
Applicant’s or agent’s file reference
Facsimile No. +41 22 910 06 10
International application No.
(if known)
International filing date (day/month/year)
(if known)
Applicant or agent’s name and address
Telephone No.
Facsimile No.
The applicant or agent hereby requests the receiving Office of the International Bureau (RO/IB) to debit the following
amount from the credit card identified below.
Amount: ____________________________________
___
(currency)
Credit Card Information
Credit card:
*
**
Visa*
MasterCard/ Eurocard*
American Express**
Currencies accepted: Swiss franc (CHF), Euro (EUR) or US dollar (USD)
Currencies accepted: Swiss franc (CHF) or US dollar (USD) only
Credit card number: _________________________________________
Credit card expiration date: ___________________________________ (month/year)
Name as it appears on credit card: ___________________________________________________________________
Credit card billing address: ________________________________________________________________________
Cardholder’s signature: ______________________________________ Date: ______________________________
Warning
The International Bureau will not include this form among the documents available for public inspection.
The RO/IB will not accept payment by credit card if the cardholder submits credit card information on any form
or document other than this form, and will not be liable for the consequences of any such submission. Failure to
use this form may result in the release of your credit card information.
Form PCT/RO/197 (RO/IB) (August 2006)
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