EFTA00186519

MESSAGE CONFIRMATION



01/24/02 16:11
ID=PALM BEACH NATIONAL BANK


<table border="1"><tr><td>NO.</td><td>MODE</td><td>BOX</td><td>GROUP</td></tr><tr><td>S11</td><td>TX</td><td></td><td></td></tr></table>

<table><thead><tr><th>DATE/TIME</th><th>TIME</th><th>DISTANT STATION ID</th><th>PAGES</th><th>RESULT</th><th>ERROR PAGES</th><th>S.CODE</th></tr></thead><tbody><tr><td>01/24 16:11</td><td>00'29"</td><td>M&amp;I APPLICATIONS</td><td>001/001</td><td>OK</td><td></td><td>0000</td></tr></tbody></table>

# CREDIT CARD ACCOUNT MAINTENANCE
## Credit Card Services

**Acct #**
Name
Business Name

**Close Account**
- **Cards Returned**
- **Re-open Account**
- **Add Soc. Sec. #**

**Add Telephone #**
- **Home**
- **Business**
- **Name Change**
  From:
  To:

**Address Change to**
City, State, ZIP

**Add Cardholder**
- **Order Card**
- **Delete Cardholder**
- **Add Authorized User**
- **Order Card**
- **Delete Authorized User**
- **Add Credit Rating**
- **Add Type Code**

**Add Automatic Payment Deduction**
- **T/R/#**
  - **Checking Acc#**
  - **Minimum payment**
  - **Previous balance**

**Delete Automatic Payment Deduction**
- **Add Email Address**
- **Add Mother’s Maiden Name**
- **Add Secondary CH SS#**
- **Add Secondary CH DOB**
- **Add Secondary CH Daytime Phone**

For Marital Property States Only
- **Married**
  - Not Married
  - Legally Separated
- **Spouse’s Name**
- Street Address
- City, State, ZIP

Card Issuance
- **Order New Card for**
  - Must mark below to indicate the type of card ordered
  - Send Card:
    - Normal Delivery – 7 to 10 days
    - Express Delivery – 2 days ($10.00 charge)
    - Saturday Delivery ($10.00)
    - Fastcard – 1 day ($20.00 charge)
  - Saturday Delivery ($10.00)
  Charge: □ Cardholder □ Financial Institution
  Address to Mail Card:
    Name
    Street Address
    City, ST, ZIP
    Charge Cardholder Replacement Card Fee of $

PIN Issuance
- **Order PIN Reminder**
- **PIN Federal Express – 3 days ($10.00 charge)**
- **Charge:** □ Cardholder □ Financial Institution
- **Send PIN to Alternate Address Below**
  Name
  Street Address
  City, State, ZIP

Balance / Payment Transfers