Metavante credit card account restriction form for an account holder

EFTA00186531¶

A/P Tracking Number:¶

Metavante Corporation¶

Credit Card Services¶

Account Number: Name: Valdson Cotinio Street Address: City: Nes LLC Business Name: Nes LLC State: ZIP¶

Collections¶

• Restrict Account – R9
  • Zero Cards to Reissue
  • List on Exception File
  • Restrict on ATM Access
  • Stop Interest
  • Stop Late Charge
  • Stop Statements
  • Stop Overlimit / Past Due Notices
  • Minimum Payment Due This Cycle
  • Fix Payment
  • Re-Age account
  • Erase Past Due Stats
    • 31-60 # times
    • 61-90 # times
    • 91-120 # times
    • Erase All
  • Remove R9 Restrictions

Monetary Changes¶

• Limit Increase to $5,000
  • Limit Decrease to $
  • Change Corporate Account Limit to $
  • Reverse Finance Charge of $
  • Reverse Late Charge fee of $
  • Reverse Over Limit fee of $
  • Reverse Insurance Fee of $
  • Reverse Current Membership Fee
  • Waive Membership Fee Permanently
  • Reverse Replacement Card Fee $
  • Reverse Convenience Fee $
  • Reverse NSF Fee $
  • Reverse Insurance Premium Fee $
  • Reverse Returned Check Fee $

Free Text Messages/Miscellaneous Instructions¶

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Financial Institution Name:¶

Authorized Signature: [Signature] Print Name: [Print Name]¶

For Metavante Use Only:¶

Completed by Verification: [Date]¶

213-909-MISBSe (1700)¶

Fax R9 requests to Collections, others to Account Processing,¶

[Formatted with placeholders for actual data]¶