EFTA00186520

2082-1 LsanQoD pw

# Metavante Corporation
## Credit Card Services

**ACCT #**
Name: Emily Taylor
Business Name: Nes, LLC.

**Account Record Changes**

- **Close Account**
  - Cards Returned
  - Cards Not Renewed
  - Re-open Account
    - Remove Reissue Block
  - Add Soc. Sec.: #
  - Add Telephone #
    - Home
  - Business
  - From:
    - To:
      - Address Change to
        City, State, ZIP
      - Add Cardholder
        Order Card
        Delete Card
        Add Authorized User
        Order Card
        Delete Authorized User
        Delete Credit Rating
        Add Type Code
        Delete Type Code
        Add Automatic Payment Deduction
        TR#
        Checking Acc#
        Minimum payment
        Previous balance
        Delete Automatic Payment Deduction
        Add Email Address
        Add Mother's CH SS#
        Add Secondary CH DOB
        Add Secondary CH Daytime Phone
        Add Fax Number
        Add Cell Phone#
        Add Pager Number
        Privacy Option

**Insurance**

- Add Insurance
- Delete Insurance
- If adding insurance, attach a signed copy of the insurance application

**Free Text Message/Miscellaneous Instructions**

---

**For Marital Property States Only**

- ☐ Married
- ☐ Not Married
- ☐ Legally Separated
- Spouse's Name
- Street Address
- City, State, ZIP

**Card Insurance**

- ☐ 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 Insurance**

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

**Balance / Payment Transfers**

- Transfer balance of $
  - From account #
  - To account #
  - Transfer payment of $
  - From account #
  - To account #

**Convenience Checks**

- ☐ Send Convenience Checks – # of books
  - Name
  - Street Address
  - City, State, ZIP

**Financial Institution Name:** PB0B
Authorized Signature: Ann Curtis
Print Name: Ann Curtis
3-Day notice (2018)
Fax to Account Processing,

$$\frac{PBNB}{Gan SL4} \times LUAPG+$$