Text extracted via OCR from the original document. May contain errors from the scanning process.
EFTA01700895
Colonial
BancGroup.
August 22, 2006
Via Federal Express
West Palm Beach, Florida 33401-6235
Re:
Subpoena Issued to Colonial Bank
Dear Ms.
and Agent Kuyrkendall:
I enclose herewith Colonial Bank's Response to the Subpoena Duces Tecum issued to its
Research Department in Birmin am, Alabama, on or about August 2, 2006, regarding VISA
Account Number
, Jeffrey Epstein,
a
Janusz
Banasiak,
and Alfredo Rodriguez. Also enclosed is a statement representing
fees incurred by Colonial incident to its photocopying of the documents responsive to the
subpoena.
Thank you for allowing Colonial Bank an extension of time within which to respond to
the subpoena.
DBBjr/pac
Enclosures
EFTA01700896
PO BOX
MADISON V.h S37O14111
JANUSZ DANASLAR
.
NES LLC
457 MADISON AVE FL 4
NEW YORK N
100224643
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
O51DOS
TOTAL ACTIVITY
158'7.44
ENOS
ce MEMO STATEMENT WILY "
00 NOT REMIT PAYMENT
SUMMARY
ANNIS=
Cimmed./ Tam
_CARDHOLDER
PuithISS8
Core
And Other CMS,'
•
Advances
-
SIBT44
10 .00
Olean
t0 0C
r
Tool
Acdrity
11$7 41
Post Tran
Nth Dila
Reference Number
TTINIssalor. Doscrlollon
STOWE
05-24 06-23
US9213141 roll0o.S0010032S
NOTICE Undo MPS Lan] BELOW saxeceisrwIngsea•I'mcwomara
ASIA GRILL 211-7SSSIBE NY
M32 BS
05-2S GS-24
24141C4AW.cO196.5OOO2.92
MtS20
Orr2S 0646
24O13113146OO1585S32119
CIII
FUN NEW YORK NY
M39.27
0540 03.25
24116O4614BOO14917716O9
M26.20
05-29 05-27
24323O3O144122436O.1OSt9
PATSY'S AT SAM STREET NEW YORK NY
Me3.82
AIWIA4
Account NUMMI
AMOUNT SUMMARY
TOLL FREE
146O421-W6
STATEMENT DATE
PURCHASE& &
INTERNAT/ONAL
1.6064A0.7700
01/16/06
Oita CHARGES
5167.44
CASH A0VANCES_
Rf1.—
SEND DitglIIRES To:
CREDIT LIMIT
12,000.00
ADV.INE Fa.
cc
DISPUTED AMMO'
AMERME-
.00
poscrAim
MADISON WI S57014 111
30.00
TOTAL ACTIVITY
15167.44
Pavel al 1
EFTA01700897
AUG-16-2006 15:28
P.04
PO BOX 1111
MADISON Yin 53701-111i
e
Inbind
.....
JANUSZ BANASIAR
NES LUC
457 MADISON AVE FL 4
NEW YORK NY
IDOZB-6843
COLONIAL BANK
MEMO STATEMENT
ACCOLINTNUMBER
STATEMENT DATE
05-18-08
TOTAL ACTIVITY
542.04
MMO
int MEMO STATEMENT ONLY "
t
Catdholder Total
Koenste
Cash
And Otter Debra
•
~inca
-
SOM
$0 00
Giedts
14.00
Total
Acdirke
$42.04
Post Tran
Date pitte
Riiirmanos Numbor
TransactIon Destriplign
Amount
NOTICE MEMO 1214 USTED BELOW ran"
05-06 05-04
24299578125208694100823
LEGENDS #11 WEST PALM BEA FL
M42.04
TOTAL ~GUNT OF MEMO ITEMS):
$42.04
WST/OTDLE11 CARDS CALS
7O1.1 FREE
1.800-2214920
INTERNATIONAL
1.808240-7700
ACCOUNT NUMBER
STATEMENT DATE
85118/06
ACCOUNT SUMARY
PURCHASES &
OTRER CHARGES
$42.04
catorr LIMIT
n
ir"
°n
CASH ADVANCES
.Q0
"%WC La A rtt /A birg
C ree
res
EFTA01700898
scovub
1St 29
P . 05
Neor••••• I in
• ••••
• .anapill
Vie
I
M
DOESIMIIIN
11
-
V
i N01,••••0
DISPUTED AMOUNT
10.00
COEDITS
TOTAL ACTIVITY
At_
54204
Page 1 of 1
EFTA01700899
AUG-16-2006 15:28
-4-
P.06
I
I
PO BOX 1111
MADISON W158701-1111
JANUSZ BANASIAR
NES LLC
457 MADISON AVE FL 4
NEW YORK NY
18DZZ-6843
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMIDIT DATE
04-17-08
TOTAL ACTIVITY
6472.19
1.111.
1
Puttheses
Cash
And Other Debits
+
Ateratme
-
4472,19
60.00
Crone
SAN
=
Total
Activly
$472.19
Don iron
DS Dale
Re mane Number
TritheaelIon Daseriolien
Amount
03-17 03-17
M213.00
24293516076207795400020 NOTICE
WILTED BELOW atngte:Cflin'
MEMO
AND
GRECS BODY
PAINT 5618335626 FL
03-97 03-2e 24275306086766763254564
M198.07
76935455
04-11 04-10
24755426101641011093145
M81.12
4472..19
TOTALMIDUNT DESEMO ITEMM6
TOLL FREE
1.800.2214620
INTERNATIONAL
1-60B-2404700
ACCOUNT NUMBER
STATEMENT DATE
ACCOUNT SUMMARY
PURCHASES &
DUlT/06
OTfiER CHARG€S
5472.16__
CREDIT LIMIT
ill MI% NI
CASH ADVANCES
ritela AMfalilt-C reCc
.00
net
EFTA01700900
AIMI- 16-2006 16:28
MADISON WI 53701-1111
DISPUTE RESOLUTIoN
Po BOX
DISPUTED AMOUNT
$0.00
• fltie
tNel.. • tirY
CREDITS
•
V
y
.00
TOTAL ACTIVITY
562.18
Pape 1 or I
P . 07
EFTA01700901
AUG-16-2006 15:28
P .
08
•
PO BOX 1111
MADISON WI 53701-1111
1111111111111/ aaaaa
JANUSZ BANASIAR
NES LLC
457 MADISON AVE FL 4
• NEW YORK NY
10022-6843
COLONIAL DANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
03-16-05
TOTAL ACTIVITY
8243.83
M00144
x" MEMO
OT
STATEM
PAYMENT
ENT ONLY PP
DO N
REMIT
Deronomerr
Purchases
CINA
And otror 0ebto
4
Advances
-
5243.88
8000
Credal
SO 00
r•
Thai
Amity
$24123
Post Tan
_DOI DM*
Reference Number
Transaolfon Description
Amount
NOTICE MEMO ntims.ustro BELOW zuzanceessaw"cwneone•
02-10 09-10
24798488071050874651769
M243.82
TOTAL AMOUNT OF MEMO 'TEAMS):
_5243.83
YOU. FREE
1-800-221-5920
INTERNATIONAL
1.608.2s0T700
ACCOUNT NUMBER
STATEMENT DATE
03/15105
ACCOUNT SUMMARY
PURCHASES &
OTHER CHARGES
$243.83
CREDIT LIMIT
co 111111 till
CASH ADVANCES
.00
ractl
ATM ia •IrC =CC
EFTA01700902
nut,- le- 2006
15:28
P.09
„
$REP1V
AO
Disponi) Amount
PO BOX 1111
MADISON WI 53701-1111
so.00
TOTAL ACTIVITY
$243,03
Pegs 1 of 1
L
c
EFTA01700903
ADO- 16- 2006
15:28
-
P . 10
PO BOX 1111
MADISON WI 53701-'1111
imaginal
ttttt
loin' in Urinal
Lehi'
JANUSZ BANASIAR
NES LLC
457 MADISON AVE FL 4
NEW VORK NY
10022-6843
COLONIAL DANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
02-16-06
TOTAL ACTIVITY
$637.37
oges2a
Your total finance thMte Dald 1W 2005 was 0.00.
al
~iiii
m
ConihoIcteeTtaal
Purr:hawse
Cash
MS offier Debt
-1.
/Mama
-
ía97.97
5000
gees
5000
a
Total
Actiwty
$1537.37
Post Tran
Date
Reference binreker
Transaction DescrktiOn
Arnowit
,amontok NOTICE LIE1140 ITEMS LISTED BELOW
01-17 01-17
24928886017206144300558
GULF STREAM MOTORS 40765143453 FL
M208.63
02-14 02-14.
24445006048377641803610
M354.74
0245 02-14
24184078045974253950466
sentratuttocanuournatet
RACETRAC562 00005029 W PALM BCH FL
M14.00
5637.37
TOTS AMOUNT DE MEMO REINS>:
TOLL FREE
1-600-221-5920
INTERNATIONAL
1.605240.7700
ACCOUNT NUMBER
STATEMENT DATE
02/141/06
ACCOUNT SUMMARY
PURCHASES &
OTHER CHARGES
CASH ADVANCES
5827.37
CREDIT LIMIT
to mn
nralnurt
CCCe
.00
EFTA01700904
Auu-15-2006 15:29
P . 11
r
i
I
PO SOX 1111
MADISON WI 53701-1111
u.......ems.rowertfl,...-.L.Lohat..
[........
m.deayik......
DISPUTED AMOUNT
CREDITS
30.00
TOTAL ACTMTY
5637.37
Page 1 of I
a
F
I
EFTA01700905
AUG-16-2006 15:28
P.12
cmoiromTeral
1
PO LICM 1111
MADISON WI 53701.1111
,,,,,
.JANUSZ BANASIAR
NES LLC
457 MADISON AVE FL 4
NEW YORK NY
IDOZZ-6843
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
01.16
TOTAL ACTIVITY
52.849-42
m MEMO STATEMENT ONLY m
. DO NOT REMIT PAYMENT
Your total finance sham Odd far 2005 was 313»
cARDHOLDERSUNIMARY
Purchase*
And Dthar Debits
nadu3.42
Cash
Adulate
Credit;
MOO
;MO
Tool
hcavay
F2.84a,4?
Post Tran
Date oase
Raferrance Number
tart
12-19 12-19
24328885353209144100242
12-22 12-22
24108395356644476.4853
TraMALOOan DE:Shattiah
NOTICE MEMO ITEMS LISTED BELOW mum.
GULF STREAM MOTORS 4076888363 FL
HH1154845
01-02 01-02
2416838600264245453476
DOLLAR RENT-A-CAR P81000 WEST PALM BEA FL
NMteam
01.03 01-02
24402698003900600300673
01-03 01-t3
24892166003000223228*11
HAMMACHER SCHLEMMER 800-233-4600014
01-06 01-06
24403686008850600901457
01-09 01-07
24926260_08207499700355
7
45593080~002791650
01-09 01-08
2
01-16 01-15
24692166018000839988850
SHELL OIL 20030305419 FORT LAUDERDA FL
-weg
Amount
M311-62
M898.38
M693.71
M180.15
M384.14
Me6.00
M/18.52
M231_99
M74,93
12.B49.4
TOLL FREE
1.800.2215920
INTERNATIONAL
1-808-240-7700
ACCOUNT NUMBER
STATEMENT DATE
01/18/06
ACCOUNT SUMMARY
PURCHASES IL
OTHER CHARGES
SU/49.42
CREDIT UMIT
nnn en
CASH ADVANCES
.00
r AC1.4 A TM hirg CCC4
fin
EFTA01700906
AUG- 16-2006
15:29
vihdpoW.w
-a...-. •-•••••rnylaaotc-___—
"dw
P. 1 3
•
DISPUTED AMOUNT
CREDITS
.00
PO BOX 1111
MADISON WI 58701-1111
MOO
TOTAL ACTIVITY
52.84.942
Page 1 el 1
I
EFTA01700907
AUG- 16-2006
15:29
P.14
PO BOX 1111
MADISON WI 53701-1111
ititticidiniiiiirlyábalitillimiezieli •
JANUSZ 8ANASIAR
NES LLC
457 MADISON AVE FL 4
NEW YORK NY
10022-6843
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
12-18-05
TOTAL ACTIVITY
$1,682.16
00 MEMO STATEMENT ONLY m<
CARDHOUgR SUMMARY
Purchaser
Cash
And Mar Dab
Aorentee
-
ConfhoIderTotat
I
$1.862.16
jQQQ
ormits
sato
Total
AeWly
$1.862.16
POD Tran
Date Date
ReAlran04 Number
Transaction DaicriPlIon
101130=c0dgentritteflina
NOTICE MEMO ITEMS Limb BELOW
11-17 11.16
24184055321837000006240
EXXONMOBIL87 07894391 WEST PAL FL
11.21 1141 24268575326206698100689
LEGENDS #11 WEST PALM BEA FL
11-23 11-22
24254775927452919200500
11-25 11-24
24470975331900012100168
CAFE I! EUROPE PALM BEACH FL
11-28 11-27
24106385881642439403073
DOLLAR RENT-A-CAR PBI000 WEST PALM BEA FL
H H1
03420
12-02 12-01
24610435336010160828802
THE12
HOME DEPOT 6306 PINECREST FL
12-1.4 12-14
24288575342205899100700
LEGENDS #11 WEST PALM BEA FL
Amount
M85.01
M28.39
M80.70
141213339
M968,15
M500.00
M27.92
$1.863,18
TOLL FREE
INTERNATIONAL
1-800-2214920.
1-608-240-7700
AccouNT NUMBER
STATEMENT DATE
12/18/05
ACCOUNT SUMMARY
PURCHASES &
OTHER CHARGES
s1á62.16
CREDIT OMIT
CASH ADVAµCEo4
rnau
arno414/-C cccc
EFTA01700908
AUG- 16-2006 15:29
P . 16
4,40.WMA•••••
I
I I ruoEFII.Echi2—'011----
CREDITS
00
DISPUTED AMOUNT
J
PO BOX 1111
MADISON WI 53701-1111
50.00
TOTAL ACTIVITY
$1.682.16
Page I• of I
I
EFTA01700909
AUG-16-2006 15:29
P .
16
PO BOX 1111
MADISON WI 53701-1111
aaaaa
JANUSZ BANASIAR
NES LIC
457 MADISON AVE FL 4
NEW YORK
NY
lon2-6843
3
•
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
11-164)5
TOTAL ACTIVITY
si,eactss
N3Nac
'q' MEMO STATEMENT ONLY "3,
iniiiiM
~Total
Purchases
Gash
MO Offies Debb
4
Advance
-
Creels
f1,62856
$0.03
WO
Total
Actny
S1,628.55
Post Wen
Date Dale
Befeteince Number
Transaction Description
/flaunt
NOTIce MEMO ITEMS USIED BELOW •
10-15 10-17
10-21 10-20
24208575291205690100591
24208575254206699100929
#11 WEST PALM BEA FL
LEGENDS
1 WEST PALM BEA PL
LEGENDS
M22.89
M21.07
10-24 10.24
24246515297200399100011
M292.13
10-31 10.29
2410938530242431832363
DOLLAR RENT-AcAR Faioo0 WEST PALM BEA FL
M577.24
HH7029044
10-81 10-29
2420$675.903205£99100442
LEGENDS 11 WEST PALM BEA FL
M1&62
11-01 11-01
24266575305205688100609
LEGENDS
1 WEST PAW BEA PL
M35.40
11-03 11-02
11434 11-03
240C4765307315035690104
24184075308426052002573
°REECHO E STEAK HOUSE WEST PAW BCH FL
CHILI'S 44111000001107 WEST PALM BEA FL
Wass.
M22oh
11-04 11-04.
2.17828.7.53032864.93000414
CHINA FUN NY NY
M27.11
11439 11-08
24156135313101912140045
SILVER STAR 212-2494250 NY
M18.10
11-0911-08
24403695313900631301259
M73.16
11-1411-12
11-14.11-13
24410002016318240932309
247170553177331743591361
M1
M14A0
0/5
11-14 11-12
2423035311122241010857
PATSY'S AT 69TH STREET NEW YORK NY
M28.87
11-14 11-12
24071055317907127074405
TATANY 72 NEW YORK NY
MS7.60
11-16 11-15
EXXONMOBIL87 07894991 WEST PAL FL
MOSL21
JOIXISOSOCO•
COMMIS
mg, Ammo- OF MEMO ITEMS);
11.9:26.66
ton/swum CARDS CALL.
TOLL FREE
INTERNATIONAL
1400-221-5920
1.608-240-7700
ACCOUNT NUMBER
STATEMENT DATE
11/16/05
ACCOUNT SUMMARY
PURCHASES &
OTHER CHARGES
suaess
CREDIT LIMIT
tannneln
CASH ADVANCES
t- AC•1 Arntantre evrEca
.00
M
EFTA01700910
AUG-16-2006 15:29
P .
17
•asa.
1/4 f
f\•••• •
• III I
_put
DISPUTED AMOUNT
CREDITS
02_-
PO BOX 1111
MADISON WI 53/01-1111
S0.00
TOTAL ACTIVITY
rymius
Plige 1 O( I
EFTA01700911
AUG- 16-2006
1----
15:29
PO BOX 1111
MADISON WI 53701.1111
,
MIMI
!
kkkk _11.11.11.11_61 0_11_11_1
JANUSZ DANAsIAR
NES LLC
457 MADISON AVE FL 4
NEN YORK NY
1002Z-6643
COLONIAL DANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
10-1T-05
TOTAL ACTIVITY
$14.80
" MEMO STATEMENT ONLY "I
dillilliMI
Cardineter Tow
Putehamo
And OPE Debits
12.196.02
Cash
•
Adtarom
-
_IA.00
CresIts
S2 161 12
••
TOW
AaMty
£14.80
Pon Trap
Date Rite
RSteenCe Number
Tranuclien Description
" ace mmtn"xen
, NOTICE MEMO ITEMS LISTED BELOW
09-20 09-20
24610435253072000003211
CO-21 09-21
74610436264072000002712
09-29 08-28 2S2301=15S
aiatiat
ionalL
0O
ZZA
D0AQ09 W PALM BEACH FL
TOLL FREE
PURCHASES &
OTHER CHARGES
CASH ADVAIESD____
rne..i AM/M.O. 0 CCM
MOM
Ammo
M2,101.12
M2i
61.12 CR
14.90
14.99
P . 18
EFTA01700912
I
I
Am- 16-2006 46:29
PO BOX 1111
MADISON WI 5 37 01-11 11
i
••••••••
•.•
DISPUTED AMOUNT
LCREDITS
2.91172- 1
$0.00
ITOTALACTIVITY
S14.80
Fa00 1 of 1
P.19
EFTA01700913
CudholierToral
p0-16-2006
rr
15:29
Po BOX 1111
MADISON WI 53701-1111
I._
11_11-
I
I
I
I
I
1
1
I
I
I
I
I
JANUSZ BANASIAR
NES LLC
457 MADISON AVE FL 4
NEW YORK NY
10022- 6843
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
09-16-05
TOTAL. ACTIVITY
$789.46
ter14.1
414 MEMO STATEMENT ONLY >a
PUichucos
Cush
Ammer Debbi
Addenda*
SMSAll
S0,00
Officals
50.00
Total
Acta*
$78948
Past Wart
Date Dale
Relere0Fe Number
Transeetion Description
Amount
NOTICE MEMO ITEMS USTED BEUSW 40s 442044
seem
09-05 09-03
24403049447800524800285
IMPROV CITY PLACE 581.8331812 Ft.
Wage
24246515253934705900023
06-12 09-10
Mee 1.60
"4""2" 141 TOTAL AMOUNT OF MEMO ITEMISE
t
5789.411
TOLL FREE
INTERNATIONAL
1400-221-5920
1408.240-7700
ACCOUNT NUMBER
STATEMENT DATE
09/16/05
ACCOUNT SUMMARY
PURCHASES &
OTHER CHARGES
$789.48
P.20
CREDIT LIMIT
CASH ADVANCES
.00
r-ncw Any ntara ctcq
nn
EFTA01700914
nvumlb-huub
15:29
PO BOX 1111
MADISON WI 53701-1111
P . 21
"
a
w
•
DISPUTED AMOUNT
I CREDITS
SUDO
TOTAL Acorn,*
Page 1 of 1
EFTA01700915
AUG-16-2006 15:29
- -1--
P . 22
COLONIAL BANK
MEMO STATEMENT
PO 60%1111
ACCOUNT NUMBER
IMOMI
MADISON WI 53701-1111
STATEMENT DATE
03-16-03
.....
JANUSZ BANASIAR
NES LLC
457 MADISON AVE FL 4
NEW YORK NV
I 0 OZZ —6843
TOTAL ACTIVITY
172,207.97
MOO=
a
MEMOoT REMIT
STATEMENT ONLY
T
a
DO N
PAYMEN
•
1i~
CarctekkecTotel
Fueling.»
Cash
And Oder Debits
. +
Advances
-
32,29727
9000
Creas
50.00
=
1
Tom!
Aabiq
82287.97
Rost T)
Dale Data
Reference Number
'transaction Description
liaaMlied~SPIOVIat
NOTICE MEMO rags LISTED /m ow vleamecceeec~mormanzamc
AMMO
07-21 07-21
243281185202043144200497
M622.92
08-04
came
ne
0808-088
08-0e
08-08
08-07
06-08
24782825217288489800813
CHINA
24246515219207309700088
INDIAN
24403885220900522000434
MEDITERRANE0
24810445221010151784855 THE
FUN NY NY
NEW YORK NY
HOME DEPOT 0390 WEST PALM BCH FL
M1
Mel
M55.70•
,563.78
TOTAL AMOUNT OF MEMO fTEMISS
92297.27
FOR cusTomER SERVICE OR
TOLL FREE
1-600-221-5920
INTERNATIONAL
1-608-240-7700
ACCOUNT MUNIDER
ACCOUNT SUMMARY
PURCHASES to.
OTHER CHARGES
52.297.97
STATEMENT DATE
ovieros
CASH ADVANCES
.00
CREDIT LIMIT
ton/am
PAC" AM/MI.1K CgCC
nn
EFTA01700916
marie-2006 15:29
li+1•••••r I
"LI
•••
P.23
;
ERES
DMPUT
OUMON
CREDITS
DISPUTED AMOUNT
POBOX1111
MADISONW153701-1111
S0M0
TOTAL ACTIVITY
$2.a97.97
Page 1 of 1
EFTA01700917
AUG-16-2006 15:30
P.24
PO BOX 1111
MADISON WI 517014111
JANUSZ BANASIAR
NES LLC
457 MADISON AVE FL 4
NEW YORK
NY
10022-6843
!
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
STATEMENT DATE
OT-18-05
TOTAL ACTNITY
S249.99
Nr10O4
04 MEMO STATEMENT ONLY 101
cartokunTotal
And Oiler Debts
+
Arnintes
-
624949
50 .00
Ccullle
$0 .00
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2'717055178551750123371
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M249.99
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TOTAL AMOUNT OF NEMO ITEMISt
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1.500.2215920
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1-608-240-7700
ACCOUNT NUMBER
STATEMENT. DATE
CI7/18MS
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PURCHASES &
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5246.89
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EFTA01700918
AUG-16-2006 15:30
P.25
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S249.39
Page 1 of 1
EFTA01700919
AUG-16-2006 15:30
P .
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PO BOX 1111
MADISON WI 53701-1111
COLONIAL BANK
MEMO STATEMENT
ACCOUNT NUMBER
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06-18-05
TOTAL ACTMTY
51.712.513
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51,71259
EFTA01700921
AUG-16-2006
15:30
P.28
PO BOX 1111
MADISON WI 53701-1111
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JANUSZ BANASIAR
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NEW YORK
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1-800-221.5520
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1430B-240-770D
ACCOUNT NUMBER
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05/16/05
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51.676.31
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80.00
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51,676.31
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A10-16-2006 16:32
o2/18/2002 o0:3,1 FMC SOB 222 2830
M & I DIRECT
Page 1 oil
P.48
1
•• 1;
E
$
6
•
Posting Date 2005 Jul 12
Box No.
200
Batch
200000&
Sec No.
164
Amount
$11,259.46
Account No.
EFTA01700941
AUG-16-2006
.!
15:32
P.49
Page 1 of 1
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•.
••••••••••
771
PO BOX 1111
MADISON '1151701-1111
LlinAh.LUI
COLONIAL DANK
CREDIT CARD pRoCESSINO CENTER
PO BOK 3052
MILWAUKEE WI 51201-5052
NES LLC
457 MADISON AVE Fl 4
NEW YORK
NV
10022-6143
COLONIAL BANK
ACCDUKY NUMBER
MEM
otfooS
AMOUNTPUE
2712.00
=SWEAT VALANCE
$14.370.V2
AIMIONTOMMMO
$
au
Rail Mal! CrECIC IMIA011
If you Note MIMOSA teltOtneio BANTAM
Ma payment amount that you have
authorized (new balance or minimum
payment) veil be debited two burets dew
alter the payment clue date.
the Kai= OW TM IMBUESCE SW" APPIIM
1/411511\SMOOWOFT414BEITYCII Mint
Posting Date 2005 Jun 13
Box No.
200
Batch
2000046
Seci No.
225
Amount
$14,370.92
Account No.
Payments received et other than th■
remit to address on the face of Mk
idetement may be eubieol to a delay In
crettehtA of up to 5 days attar to data
d tempt
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EFTA01700942
AUG-16-2006 15:32
P .
50
Page 1 of 1
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Posting Date 2005 km 13
Box No.
200
Batch
2000046
Seq No.
226
Amount
$14,370.92
Account No.
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EFTA01700943
AUG-16-2006 15:32
P.51
Page 1 of 1
PO ERA .ITIT
kilkoiDON
53101-1111
COLONIAL SANK
Atteouwr muting
Rata DUE DATE
ofriD•05
AmIDIJNY DUE
snare
bhholl.AJH
IhJhUmishhohhhholIJJI
CAIMISIT IRAUINCt
1116,$73.21
COLONIAL BANK
AMODOTOMmATED
PO pox 3052
MILWAUKEE VI 53201-3052
$
457 MADISON AVE FL 4
NEW YORK
NY
10022-604s
mat
LIAM SAO Mgt PAYAIALL
TO DAMr.can BERME;
ti yoll have ILISMOITDDO alitorrea paymetat
the payment amount that you have
authorised (new balance or minimum
paynwitt) wU its debited two blainele days
ear the payment due data.
MI6 .Dow.. lit PEVESISE ®DE SOLO AWOM
vitnewiltoovicamiesernaksonsava
Payments received at other man the
remit to addreas on the face 0 this
statement may be subject to a delay Si
of
cream of up to 3 days atter the Cal.
reeeipt.
•• •
Posting Date 2005 May 06
Box No.
200
Batch
200002$
Seq No.
79
Amount
$15,573.36
Accotmt No.
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EFTA01700944
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TOTAL P.52
EFTA01700945
Colonial Bank
2000 Palm Beach lakes Blvd
West Palm Beach, R 33409
Tel: 561-616-4065
Fax: 561-616-4092
To:
Metavante
Fac
From:
olonial Bank Date:
1/12/2005
Re:
Limit Increase
2
cc:
K Utgent
CI For Review '
K Bente Comment
K Pease Reply
K Please Recycle
ATTENTION:
Please contact me if you have any questions. Thank you.
Merchant Services
Colonial Bank •
EFTA01700946
M&I Data Services
EFD Card Services
'
Account
Code
Name Line 1
Date
Keyed by
verified by
PSC DOC 0
•
Tracki
Number:.
COMMERCIA COMO PRODUCTS 1
cc,
COMPANY Skrrill
i
O
Purchasing
Please indicate Commercial Card Product Type:
O
Ntra
a --1.nsioess
O
MasterCard
Corporate
Company Name:
ATTN:
Company Address: 9 6 -last
21 51—
City get° yogic
O Bulk Ship (1:1 Reissue Daily Ship and/or O Daily Bulk Ship)
Telephone:
(i2ja..) -7,50 -
&
Organized as:
0
Corporation
0
Partnership
K Sole Proprietorship
Company Name to Emboss on Cards: A/es
1,6,
Corporate Credit Limit: Aa --; Doe).
......-
Pementage of Limit allowed for Cash Advance:
O
Annual Report ?reduction:
Iff Calendar Year
O
Fiscal Year
(Month Pi cal Year Ends)
Statement Cycle Date (Business Card/ Corporate Card):
0
6
0
10
rai
r
16
0
20
O
25
O
245
n ..-.
27
Suuement Cycle Date (Purchasing Cud Only):
O 4 O
6
O
10
O
16
0
20
0
22
O
24
O
26
O
27
If Custom File Bank Indicate Cycle:
Statement Options at
O _JetsiTheal Billing
8 -- Corga
ilil
orat
line
"led Corporate Statement
O Summarized Cotporate'Suncencut
O No Individual Memo Statement
*Changing this option requires a new set-up, Including new ends, which are issued at the expense of the bank.
Membership Feet
An annual membership fee of S
will be assessed for the first
to
cord(s) issued, S
per card it
to
cards
are issued, S
per card if
to cards are issued, and S
per card if
cards are Issued.
Month to Bill Annual Membership fee:
0
'Default to Currant Month
O
Other
Waive Membership Fee:
aniermanently
O
First Year
O
Six Months
Company Number:
State: A) y
ZIP Code: 1O0 a
I
ErOther:
Maximum of 24 Characters
Exaltation;
Month for Card Expiration:
0
Default to Current Month
O
Other
Minimum Card Age:
Year for Card Expiration:
(if other than default)
Miscellaneous Processing Instructions:
$ECTION 111 - CONTROL ACCOUNTS (opEonal)
Control Accounts cavort select purchase categories to separate accounts that will receive their oval billing statement. Five system-defined and five client-
defined accounts are avaiable. If the maximum number and dollars are not specified, the default value is 99,990
System-Dillna
'
Category NCI
MCC Range
Credit Line
Max IS Daily Auths
Mn S Spent Daily
Account N (Card Services Use)
0 Annual Fees
N/A
ID Airline
NIA
O Car Rental
O Lodging
N/A
O Restaurant
N/A
Client-Defined
Category Name
MCC Range
Credit Line
. Max 0 Daily Auths
Max S Spent Daily
Account N (Card Services Use)
Financial Institution Name:
Authorized Signer:
Date:
233-102 MIDSbc (05,00)
Agent N:
Bank N: /.._57.57 Branch N:
S/2 'd
H3 S33IAa3S add3ANIde Wd8P:2T
60, IT Sib
EFTA01700947
:ode:
Date:
Ke edb
A&I Data Services
EFD Card Services
1ompany Name: kec
;ECTION I- COMPANY REPORTING
A/P Trackin Number:
curl) intooticIS
-s
COMPAN
I2lt.
I ONG ANDIHIER:Altt
Company Number:
1pecify the desired reporting options:
3 No reports requested (send monthly statements only).
Standard reporting at company level. Frequency and detail level as indicated.
rant® Report Manifest (cycle, summary)
TAR 410 Account Spending analysis (month end, detail, standard reporting categories)
TBR 200 Unit Cycle Statisda (month end, detail)
TBR 700 Annual Accotuit analysis (annual, detail)
MR 210 Accotiat Listing (cycle, detail)
TBR7t0 Annual Spending Analysis (annual. detail. standard pricing categritia)
Account Cycle (cycle, deoil)
tandard Annual reporting at company level. Frequency and detail level as indicated.
TBR /00 Maul Account timbals (annul, detail)
TBR710 Annual Spending Analysis (annual, detail. standard pricing categories)
Specialized reporting (please complete Section It ••• Company Reporting and the Report Options form)
;even levels of reporting am available. Each level can house up to 99.999 units. All identification numbers are 5 digits and right Justified.
?lease provide an organizational chart if necessary. Any unit not reporting to another unit will report to the company level.
2ompany Name:
Company ID tt
(Depth Reporting Level 0)
Division Name:
Unit ID it
Department Name:
Unit ID It:
Department Name:
Unit ID N:
Department Name:
Unit ID tr:
Department Name:
Unit ID N:
Additional Reporting Unit (Depth Reporting Level 3):
Unit Name:
Unit ID #:
(To define additional Depth Levels 4 - &please attach additional organizational chart)
(Depth Reporting Level 1)
(Depth Reponing Level 2)
Division Name:
Unit ID er:
Department Name:
Unit ID th
' Department Name:
Unit ID a:
Department Name:
Unit ID N:
Department Name:
Unit ID N:
Additional Reporting Unit (Depth Repardng Level 3):
Unit Name:
Unit ID N:
(To define additional Depth Levels 4 — 6, phase attach additional organizational chart)
(Depth Repotting Level 1)
(Depth Reporting Level 2)
• • g - .
{l..
Division Name:
Unit ID N:
Department Name:
Unit ID ri:
Department Name:
Unit ID #:
Department Name:
Unit ID a:
Department Name:
Unit ID N:
Additional Reporting Unit (Depth Reporting Level 3):
Unit Name:
Unit ID th
(To define additleanl Depth Levels 4 —6, please attach addiaotial otganizadonal atilt)
(Depth Reporting Level 1)
(Depth Reporting Level 2)
Financial Institution Name:
Agent it: 1111111:
Authorized Signature:
233-106 MIDSbc (04100)
Bank It: /5 5 -1
F -3/•v/
S/E 'd
HD SB0IALOS CW0MMUS Wecla7:2T
00, II sae
222£ 608 809
EFTA01700948
u
',intercom
0
Corporate
0 Purchasing
?lease indicate Commercial Card Product type:
0
VI
Business
Company Name:
•
C..
C.
Corporate Account:
Company Number:
Agent
It -0 tf
I
•••••
4 ,rti 71
re—n:r-i.l —1Yeeddrgsber
1 ft oar
Credit Line
/0, O0O •
Cash Advance Capability t _.„..,
"D" or .0 of Limit
Pin Y€2
Reporting Unit (Optional)
Div. ID Div. Name'.
Dept. ID Dept. Name
1/
\C.
G'
II
T yaxmab.le
M
yIN
E A.
i
Mothers Maiden Name (Optional)
Social Security Nurber (Optional)
Home telephone Ii (Optional)
. Acdopt.it Number (RenAcard Use)
Cardholder billing address (Optional — if not complete %rill default to Corporate billing ddress):
City
State
ZIP Code
Special Handling Instructions:
O Federal Express
O Bulk Shipment
Plastic address If different from Cardholder billing address:
City
State
ZIP Code
(
Name
Credit Line
10,006 .
Cash Advance Capability t
"D" or % of Limit
Pin Y Id
0
Reporting Unit (Optional)
Div. ID Div. Name
Dept. ID Dept. Name
General Ledger #
Assigned •
Taxable
YIN*
MEA
YIN'
Mothers Maiden Name (Optional)
Social Security Number (Optional)
Home telephone N (Optional)
(
)
tasccuinS:NUmber .(B.ankegrd OA
flcilliNVI:fs
• - A ..;:.
— .:
Cardholder billing address (Optional — if not complete will default to Corporate billing ddress):
City
State
ZIP Code
Special Handling Instructions:
O Federal Express
O Bulk Shipment
Plastic address if different from Cardholder billing address:
City
,
State
ZIP Code
ll
Credit Line
6 7. 000 •
Cash Advance Capability t
"D" o % of Limit
Pin Y
i
Reporting Unit (Optional)
'
Div. ID Div. Name
Dept. ID Dept. Name
General Ledger 0
Assigned •
Taxable
Y/N•
MEA
Y/N'
Mothers
aiden Name (Optional)
Social Security Number (Optional)
Home to
(
) 1
phone li (Optional)
:;(0,- t.11Uinber (80,ifkeeriliffige),.. ;
Cc
alder billing address (Optional - ifnot complete will default to Corporate billing ddrem):
City
State
ZIP Code
Special Handling instructions:
O Federal Express
O Bulk Shipment
Plastic address if different from Cardholdei billing address:
City
State
ZIP Code
• Pita Purchasing Cord Options
Financial Institution Name:
Authorized Signature:
233-i07 MIDSbe (5/99)
11.•Yes. NuNet, DsDefoult to CompanySeimp
yes, indica a%oflimit avail ablefor car
lit) B
Dale:
-0/
Bank
/IS?
It
AJ
Hamber.t, ;.:?:
EFTA01700949
BankCard Services ureait Led' u fl t,eaeeug re
_
•
(Please Pun
First Request O Follow-u to Verbal Ft" u
punt:
Larite
Business Name 4) 65:5
U
-
O Married O Not Married
O Legally Separated
Name and Address of Spouse
O Close Acct O Add Soc. Sec. No.
O Cards Returned O Cards Nat Returned
O Reopen Account
O Remove Reissue Block
O Add Telephone Number
Max Code
Phone Number
O Name Change From:
To:
Address Change
cout4A riga r
q5.1
4t) en Li -e---
Perk/YOrg. MV /OOa e-
iji
rdd Cardholder
O Order Card
O Do Not Order Card
O Delete Cardholder
O Add Authorized User
O Order Card
O Do Not Order Card
O Delete Authorized User
O Add Credit Rating
O Delete Credit Rating
O Add Type Code
•
O Delete Type Code
O Add Insurance'
O Delete Insurance
O Delete Automatic Parnent Deduction
O Send Balance Transfer Checks ati
.
To:
Cardholder Address
if adding insurance. attach a signed copy of insurance application.
•
O Restrict Account • R9
O Erase Past-Due Status
i O Restrict ATM Access
P times
1 - 30
O List on Exception File
31 - 60
O Zero Cards to Reissue
61 • 90
O Stop Interest
91 •120
O Stop Late Charge
Erase All
r Fix Payment;_ on
O Re-Age Account
°Minimum Payment $
LI m
ove R-9 Restrictions
Cl
Date 1,OLiase,L)L
Appcoved'By
File Number
Agent No.
ACO3Ull 8
Name Line 1
Code
Keyed by
' WNW by
PSC COC
O Umit Increase to $
(whole dodar only
O Umit Decrease to $
(whole dean only
O Change Corporate Account Umit to S
frtiois dollar only
O Reverse Finance Charge of $
O Reverse Late Charge Fee of $
O Reverse Over Umit Fee of $ •
O Reverse Insurance Fee of $
O Reverse Current Membership Fee
O Waive Membership Fee Permanently
O Order New Card for
O Charge Cardholder Replacement Card Fee of S
Send Card
O Normal Delivery • 7 - la days
(Check One):
• O Express Delivery - 2 days $10
O Saturday Delivery Add it 0
CI Charge Cardholder
CI Charge Financial Institution
O Fastcard S20
Address to Mail Card
O Order PIN Reminder
O PIN Federal Express
O Send PIN to Alternate Address
Please Provide Address Below
FREETEXT MESSAGES / MISCELLANEOUSINSTRUCTIOt
not Name of Authorized Signer
911 At? aiO 41647%
Poutba: Vorge • Moosup/NEI-LOW • Financial Outlook.,
EFTA01700950
& TRUST COMPANY
3931 RCA Blvd, Suite 3102
Palm Beach Gardens, Fl 33410
Fax Transmission cover Sheet
To:
Credit Services 608-240-7496
(Applications and Business card maintenance)
Sender:
Re:
NES LLC
You should receive 3pages(s), including this cover sheet. If you do not
receive all the pages, please call
The information contained in this message is privileged and confidential information intended for
the use of the individual or entity to whom it is addressed. If the reader of this message Is not the
intended recipient, the agent or employee responsible to deliver it to the Intended recipient; you are
hereby notified that any dissemination, distribution or copying of this communication Is strictly
prohibited. If you have received this communication in error, please notify us by telephone. Please
return the uncepied message to us by U.S. Mail. Thank you.
EFTA01700951
(Please Print)
3 First Req
.toil unt
• tile
Business Name
O Married
O Not Married
O Legally Separated
Name and Address of Spouse
O Close Acct O Add Soc. Sec. No.
-
O Cards Returned O Cards Not Returned
O Reopen Account
O Remove Reissue Block
O Add Telephone Number
-
Asia Coda
Phone Nunn(
O Name Change From:
To:
O Address Change
hillAdd Cardholder
O Order Card
O Do Not Order Card
K Delete Cardholder
O Add Authorized User
O Order Card
K Do Not Order Card
O Celete Authorized User
O Add Credit Rating
K Delete Credit Rating
O Add Type Code
0 Delete Type Code
O Add Insurance'
O Delete Insurance
O Delete Automatic Payment Deduction
O Send Balance Transfer Checks $
To:
Cardholder Address
•It adding insurance. attach a signed copy of insurance application.
O Restrict Account • R9
O Restrict ATM Access
O List on Exception File
O Zero Cards to Reissue
O Stop Interest
O Stop Late Charge
Fix Payment $
°Minimum Payments
fiumove R•9 Restrictions
O Erase Past-Due Status
* times 1.30
31 - 60
61 - 90
91 • 120
Erase All
O Re-Age Account
O Stop S
Date
a 11)
Approved By
File Number
Agent No.
FOR BANKCAR0 USE ONLY
Account
Nam Lin I
Code
Dale
• Virifild by
O Limit Increase to S
(whole dowry)
Limit Decrease to S %e NIDa
ebsat only)
K Change Corporate Account Limit to S
Mote ea& pay)
O Reverse Finance Charge of
•
O Reverse Late Charge Fee of S
O Reverse Over Limit Fee of S
O Reverse Insurance Fee of S
K Reverse Current Membership Fee
O Waive Membership Fee Permanently
O Order New Card for
O Charge Cardholder Replacement Card Fee of 3
Send Card
O Normal Delivery • 7 - 10 days
(Check One):
O Express Delivery - 2 days $10
O Saturday Delivery Add $10
0 Charge Cardholder
O Charge Financial Institution
O Fastcatd $20
Address to Mail Card
O Order PIN Reminder
O PIN Federal Express
O Send PIN to Alternate Address
Please Provide Address Below
FREETEXT MESSAGES !MISCELLANEOUS INSTRUCTIONS
Financial Institution
nt Name of Authorized Signer
911 ACT 41.0 wtallh
Foddro: *mut • Pion I scar ELLOW Fulani& nonAlon
EFTA01700952
Coil c:
Dale:
Nevnt by:
A/P Trackin: Number:
M8di Data Services
EFD Card Services
Please indicate Commercial Card Prodoet type:
K
vi
usiness
K
K
MaslerCard
Cor oralt
K
Purchasin
SECTION I — AUTHORIZED USERS
Navne
Credit
Line
Sioöb i-
Cash Advance Capability tO
"D" or % i Linul
Pin Y
Reporting Unit (Optional)
Div. ID
Div. Name
Dept. ID Dem. Name
General Lcdger //
Assigned •
Taxable
Y/N•
MEA
Y IN•
Mcilhers Melden Name(Oprionol)
Social Security
(Optional)
Number
Home telephone
(
)
II (Optional)
Account Number (EFD Lise)
Caidboldcr billing addrcss
\
City
State
-1 ZIP Code
initial Ihndling hutra/bom:
Q Fixlmal Express
Pta lic address if different from Cardliolder
Name
billing sikh
Ciedil
Lint
-ess:
Cub Advance Capability t
"D" or %of Limit
Vin Y/N
Div. ID
Div.
City
Reporting Unit (Optional)
Name
Dept. ID Dept.
State
Name
I..IP Code
General Ledget N
Assigned •
Taxable
Y/N •
MEA
Y/N•
Modiers Maidcn Name (Optiunal)
Social Sec
(Optional)
rity Number
Home telephone N (Option/)
(
)
I
/tumult Number (EFD Use)
Caniliolder billing address
City
l
State
1 ZIP Code
Special Handling in tructions:
D Federal Express
Plastic address if different from Cardholder
Name
)
billing address:
Credit
Line
Cash Advance Capability t
"D" or % of Limit
PM Y/N
Div. II)
Div.
City
Reporting Unit (Optional)
Name
Dept. ID Dept.
State
Num
ill' Code
General Ledget tl
Assigned •
Taxable
VIN'
MEA
YIN•
Mollsers Manien Name (Optional)
Social Securily Number
(Optional)
Home telephone P (Optional)
(
)
Account Number (EFD Use)
Cardholdet billing addrcss
City
State
ZIP Code
Special Handling Instructions:
Q Federal Express
Plastic address if different front Cardholdcr billing address:
City
State
..
ZIP Cosle
• Visa Purchasing Card Options
Financial Institution Name:
Authorized Signaturs:
I
233-107 MIDSbc (04700)
t
D=Defaull to Company Set-up (ifyes,
al
yes. sn l
le
af linrit avattable for
Agent #
Bank #
Sri
Date:
-6
EFTA01700953
- INES-SAGE CONF I RNA T
(PleariePah0
j First Roque
.Ie?ilun; ;
L LC
Business Name
Married
Q Not Married
O Legally Separated
Name and Address of Spouse
O Close Acct O Add Soc. Sec. No.
•
O Cards Returned O Curds Nor Returned
O Reopen Account
O Remove Reissue Block
a Add Telephone Number
Ina COdll
Phte4 NUMMI
O Name Change From:
To:
Ci Address Change
▪
add Cardholder
WO Order Card 0 Do Not Order Cud
O Delete Cerdhoider
O Add Authorized user
O OWE Card O Do Not Order Card
• OtiOle Authorized User
O Add Credit Rating
O Delete Cry% Rating
O Add Type Code
0 Delete Type Code
O Add Insurance'
Q Gen Insurance
O Delete Automatic Payment Deduction
O Send Balance Transfer Chocks I
12/06/01
12:20
ID=PALN BEACH NATIONAL BANK
Account
Hirt* Uni
Goa
Kane ty
PSC CCC g
Otte
Limit masses to $
won (rat my:
• Limit Decrease to $
l'eorecnservi
O Change Corporate Account Urrrn to $
cense dab. ar4
O Reverie Finance Charge of $
O Ravers° Late Charge Fee of $
O Reverie Over Limit Fee of $
K Rivers* Insurance Fes of $
O Reverse Current Membership Feta
O Waive Membership Fe, Permanently
O Order New Cud for
O Charge Cardholder Reptacerminl Cud Fe of $
Sand Card
O Nomial Delhi!), • 7 •
days
(Check One):
O Express Delivery • 2 days $10
O Saturday Delivery Add $10
O Charge Cardholder
Charge Financial Institution
O Festraud $20
AriCresa to Mall Cud
O Order PIN Reminder
O PIN Federal Express
O Lard PIN to Aiternate Address
Patio Provide hams; Belau
TA
EFTA01700954
TCSI 001 CODE IGB ACCT
CYCLE 16 AGENT
TBR
BALANCE
23966.57 LIMIT
$25000 AVAILABLE
$979 PAYMENT DUE
699.00 0
PAST DUE #
1
0
0
0
0
0 0
PAST DUE
$0
0 101601 00
PAST DUE $
0
0
0
0
0
0
0 VISAPHONE N
OPENED 9999 082101 HIGH BALANCE
$23966 120401 STATEMENTS
3 0 111601
000000 OVERLIMIT
0
$0 PAYMENT DUE DATE 121101
LIMIT HISTORY
$25000 0
$0 0000 0000
MAINT 000000 PRIOR MAIN? 000000
ISSUE 1559 BRANCH 0000 DOB 000000 INS N 00
0 CIT N 000000
COLLECTION Z F
101601
0
DISPUTE N 000000
.00
0000
0
0000 A:
TRANSFER
RCL N
CRS N
CR BUR 000000
N
N N
CREDIT DATA 0801 0000 0000 9008 FIRST USE R 090701
CARDS
0
0 1249 N VISA CARD REQUEST 000000 ENCODE Y PIN REQUEST N 000000
UM1 > N UM2 > N
0000
.00 AUTO DEDUCTION
UDATA >
>
>
>
>
> 67108000000000
CHECKING
SAVINGS
OAN
TRANSIT/ROUTING 000000000 OTHER CARDHOLDER
PAYMENT 111401
6483.89 CREDIT 120401 PURCHASE 120401 CASH ADVANCE 000000
N1 NES LLC
**CORPORATE BILL - CORPORATE ACCOUNT
N2 CORPORATE ACCOUNT
Al 457 MADISON AVE FL 4
A2
CS NEW YORK NY
H 0000000000 P.
10022-IIIII **OLD
HOLD N 000
**ACCOUNT IS CURRENT
EFTA01700955
(Please Print)
Driest Segue
.
"rOR BANKCARD USE ONLY
Account O
' • •
Business Name
O Married
0 Not Married
O Legally Separated
Name and Address of Spouse
O Close Acct O Add Soc. Sec. No.
-
O Cards Returned O Cards Not Returned
O Reopen Account
O Remove Reissue 13Iock
O Add Telephone Number
.
•
Area Code
Phone Number
O Name Change From:
To:
O Address Change
*
Odd Cardholder
O Order Card
O Do Not Order Card
O Delete Cardholder
O Add Authorized User
O Order Card
O Co Not Order Card
O Celete Authorized User
O Add Credit Rating
O Delete Credit Rating
O Add Type Code
O Delete Type Code
O Add Insurance'
O Delete Insurance
O Delete Automatic Payment Deduction
O Send Balance Transfer Checks #
To:
Cardholder Address
'If adding insurance, attach a signed copy of insurance application.
O Restrict Account - R9
I O Restrict ATM Access
O List on Exception File
O Zero Cards to Reissue
O Stop Interest
O Stop Late Charge
r Fix Payment
on
°Minimum Payment S
L.) Fir:move R-9 Restrictions
O Erase Past-Due Status
ft times
1 • 30
31 • 80
61 - so
91 • 120
Erase All
O Re-Age Account
O Stop Statements
Name Une I
Code
bale
Keyed by
• Verified by
PSC 0OC
Limit Increase to $
O limit Decrease to $
O Change Corporate Account Limit to S
(*de doh/ Gay
O Reverse Finance Charge of $
O Reverse Late Charge Fee of $
O Reverse Over UMit Fee of
'
O Reverse Insurance Fee of 3
O Reverse Current Membership Fee
O Waive Membership Fee Permanently
OO
a
Perth dozer oety
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'Setif cab
O Order New Card for
O Charge Cardholder Replacement Card Fea of $
Send Card
O Normal Delivery • 7 • IC days
(Check One):
O Express Delivery - 2 days $10
0 Saturday Delivery Add $10
O Charge Cardholder
0 Charge Financial Institution
O Fastcard $20
Address to Mad Card
O Order PIN Reminder •
O PIN Federal Express
O Send PIN to Alternate Address
Please Provide Address Below
um 'mar,
Rouble: WHITS • Piece stedYELLOW • Fnancial Institution
Print Name of Authorized Signer
*al Institution ch
i
File Number
Agent No.
li
(palat al
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Approved Er
EFTA01700956
(Please Print)
D First Reque
••
0
Business Name •
0 Married O Not Married
O Legally Separated
Name and Address of Spouse
O Close Acct O Add Soc. Sec. No.
O Cards Returned 0 Cards Not Returned
O Reopen Account
O Remove Reissue Block
O Add Telephone Number
ksi Cole
Phone Numb• er
O Name Change From:
To:
1O Address Change
Oa\ dd Cardholder
O Order Card
O Do•Not Order Card
O Delete Cardholder
O Add Authorized User
O Order Card
O Do Not Order Card
O Celete Authorized User
O Add Credit Rating
O Delete Credit Rating
O Add Type Code
0 Delete Type Code
O Add Insurance'
O Delete Insurance
O Delete Automatic Payment Deduction
O Send Balance Transfer Checks I
To:
•
Cardholder Address
'It adding ;Astir:Ince. attach a signed copy of insurance application.
O Restrict Account • R9
O Erase Past-0ue Status
. O Restrict ATM ACCOS3
a times .1 - 30
O Usi on Exception Fde
31 • 60
0 Zero Cards to Reissue
at • 90
O Stop Interest
91 • 120
O Stop Late Charge
Erase All
r Fix.Payment S
on
0 Re-Age Account
°minimum Payment 3
.-.3 ro:move R.9 Restriction;
Date
ACCOUrit
Name Chet
Code
%arid by
PSC DOC I
Date
• Voritlii0 try
O Umit Increase to S
*Ss matt om
)(limit Decrease lo S.
(Ade 634, 06)
O Change Corporate Account Umh to $
Myer &tar en.
O Reverse Finance Charge of $
O Reverse Late Charge Fee of $
O Reverse Over Umit Fee of $ •
O Reverse Insurance Fee of $
O Reverse Current Membership Fee
O Waive Membership Fee Permanently
O Order New Card for
O. Charge Cardholder Replacement Card Fee of $
Send Card
O Normal Oethery • 7 - tt, days
(Check One):
O Express Delivery - 2 days • $10
O Saturday Delivery Add $10
O Charge Cardholder
O Charge Financial Institution
O Fastcard $20
Address to Mail Card
O Order PIN Reminder
O PIN Federal Express
O Send PIN to Alternate Address
Please Provide Address Below
FREETEXT MESSAGES MISCELLANEOUSINSTRUC11O
Fite Number
Agent
nCial Institution
ame of Authorized Signer
.41 Lime nMl.
ROUllecj: WHITE • Piece isowYELLOW • Awed Inidiutton
EFTA01700957
AIP Track'
Number:
'IAL CARD PROM. CTS - INDIVIDUAL ACCOUNT (NFOR\IATIO\
VISA
/Business
K
K
MasterCard
Corporate
Company Number:
0 Cure
Corporate Account:
•
teraPability t ......
mit
Pin Ye...../
Reporting Unit (Oprimuit)
Div. ID
Div. Name
Dept. ID Dept. Marne
General Ledger N
Assigned •
"taxable
Y/N•
MEA
WWI
Nome telephone it (Optional)
(
)
Account Number (EFD Use)
City
State
ZIP Code
. ..............
City
Siam
_ .. —
....- ....---......-- .
ZIP Code
ce Capability I
knit
Pin TM
I Div. ID
D.
I [wit] :i1,1.:tOp..
/
v. Name
Dept. ID Om: ',.L .-
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Assigned •
To
TM'
MFA
Y/N•
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Home Mkplane N (Optional)
(
)
Account %Umber (CPU
City
State
ZIP Code
ex Capability1
irgit
Pin yrN
Div. ID
Div.
City
State
Reporting Unit (Optieroar)
Name
Dept. ID Dept Name
/JP Code
General Ledger 0
Assigned •
Taubk
TM*
MEA
TM*
Home telephom N (Optional)
(
)
Amount Number (EFO Use)
City
State
ZIP Code
City
State
I ZIP Code
O=Deftailt Io Complay Set-up Of yes. Mileage 96°11in:A available for cash)
Paaa
Agedt ti
Bank #
/ S3 7'
Date:
Z
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EFTA01700958
Code:
Date:
Keyed by:
A/P Trackin Number:
M&I Data Services
EFD Card Services
Please indicate Commercial Card Product type:
Company Name: _itie5
SECTION I — AUTHORIZED USERS
K
VISA
0--•-•017;iness
K
K MasterCard
Corporate
Company Number:
K Purchasin
Corlroratc Account:
Name 'I/aid,
OIL'
-
ej2#7- in
Credit
Line
,5f 6 61)
Cash Advance Capability t _„„r,
"D" or % of Limit
Pin Y
05
Div. II)
Div. 'tine
Repotting Unit (Optional)
Dept. ID Dept. Name
General Ledger H
Assigned •
Taxable
YIN*
MEA
YIN•
L
Mothers Maiden Nance (Optional)
Social Security Number
(Optional)
Home lekplione /4 (Optional)
(
)
Account Number (EFD Use)
)
r:ardholder billing address
City
State
ZIP Code
Special Handling Instructions:
Q Federal lixpress
Plastic address if different from Cardholde
Name
billing address:
Credit
Line
Cash Advance Capability t
"D" or %of Limit
l'in Y/N
Div. ID
Div.
City
Name
Reporting Unit (Optional)
Dept. ID Dept.
State
Name
ZIP Code
General Ledger H
Assigned •
Taxable
Y/N•
I
MFA
Yffi•
Mothers Maiden Name (Optional)
Social Security Number
(Optional)
Home telephone If (Optional) •
(
)
1
Account Number (EEO Use)
Cardholder billing address
1 City
1 State
1 ZIP Code
Special handling Instructions: a Federal Exprtss
Plastic address if different front Cardholder billing address:
City
State
,
ZIP Code
Name
)
Credit
Unc
Cash Advance Capability t
"D" or % of limit
Pin Y/N
Div. ID
Div. Hanle
Reporting Unit (Optional)
Dept. ID Dept. Name
General Ledger II
Assigned •
Taxable
Y/N•
MEA
Y/N•
Mothers Maiden Name (Optional)
Social Security Number
(Optional)
Home telephone If (Optional)
(
)
Account Number (EFD Use)
Cardholder billing address
_
City
State
ZIP Code
Special Handling Instructions:
a Federal Express
Plastic address If different from Cardholder billing address:
City
State
ZIP Code
• Viso Purchasing Card Options
t Y
Financial Institution Name:
• Authorized Signature:
233-107 MIDSbc (7
Yat Pli•No. =De y I to Company
t-up
yes. an Ica e
o inn vo
■
P.5/ (215
Agent ft
a
Dank #
/53'7
Date:
—O/
EFTA01700959
"- I
•
3/6,/o-a-
TImE ....erialJai!)9 02:37
NAME :
FAX :
TEL
DATE,TIME
FAX NO./NAME
DJRATION
PAGE(S)
04
RESULT
OK
MODE
STANDARD
EFTA01700960
%L
bi2A
& TRusr COMPANY
3931 RCA Blvd, Suite 3102
Palm Beach Gardens, Fl 33410
Fax Transmission cover Sheet
To:
Credit Services 608-240-7496
(Applications and Business card maintenance).
Sender:
Re:
Nes,LLC
You should receive 4 pages(s), includin this cover sheet. If you do not
receive all the pages, please call
The Information contained in this message is privileged and confidential information intended for
the use of the individual or entity to whom it is addressed. If the reader of this message is not the
intended recipient, the agent or employee responsible to deliver it to the intended recipient, you are •
hereby notified that any dissemination, distribution or copying of this communication is strictly
prohibited. If you have received this communication in error, please notify us by telephone. Please
return the uncopied message to us by U.S. Mail. Thank you.
EFTA01700961
A/P Tracking Nombre:
Metavante Corporation
Credit Card Services
Collections
Monetary Changes
O Restrict Account — R9
O Zero Cards to Reissue
O List on Exception File
O Restrict on ATM Access
K Stop Interest
O Stop Late Charge
K Stop Statements
O Stop Overlimit / Past Due Notices
El Minimum Payment Due This Cycle
K Fix Payment
$
K Re-Age account
K Erase Past Due Status
K 31_60
# times
O 91-120
# times
K Remove R9 Restrictions
D 1-30
O 61-90
# times
O Erase All
# times
Free Text Messages/Miscellaneous Instructions
Financial Institution Name;
Authorized Signature*
Print Name:
D Limit Increase to
S
(Z Limit Decrease to
s Soo o. aD
K Change Corporate Account Limit to
O Reverse Finance Charge of
O Reverse Late Charge Fee of
O Reverse Over Limit fee of
O Reverse Insurance Fee of
$
S
$
O Reverse Ortrent Membership Fee
K Waive Membership Fee Permanently
K Reverse Replacement Card Fee
K Reverse Convenience Fee
O Reverse NSF Fee
K Reverse Insurance Premium Fee
O Reverse Returned Check Fee
$
$
S
For Metavante Use Only
Telephone #
Bank # 75n
Agent #
Ext.
Completed by
Verification
Date
Date
233-099b MIDSbc (12/01)
Fax 129 requests to Collections, 608-240-7601; others to Account Processing, 608-240-7605
EFTA01700962
MP Tracking Numinti
Metavante Corporation
Credit Card Services
Collections
Monetary Changes
K Restrict Account — R9
K Zero Cards to Reissue
K List on Exception File
K Restrict on ATM Access
K Stop Interest
K Stop Late Charge
K Stop Statements
K Stop Overlimit / Past Due Notices
K Minimum Payment Due This Cycle
K Fix Payment
$
K Re-Age account
K Erase Past Due Status
K 1-30
K 31-60
# times
K 91-120 # times
K Remove R9 Restrictions
S
# times
K 61.90 # times
K Erase All
Free Text Messages/Miscellaneous Instructions
Financial Institution Name:
Authorized Signature:
Print Name:
K Limit Increase to
$
2 Limit Decrease to
5 qO 0O.0 D
K Change Corporate Account Limit to
$
K Reverse Finance Charge of
K Reverse Late Charge Fee of
K Reverse Over Limit fee of
K Reverse Insurance Fee of
$
$
K Reverse Current Membership Fee
K Waive Membership Fee Permanently
K Reverse Replacement Card Fee
$
K Reverse Convenience Fee
K Reverse NSF Fee
S
K Reverse Insurance Premium Fee
S
K Reverse Returned Check Fee
S
For Metavante Use Only
Telephone #
Agent #
Ext.
Completed by
Verification
Date
Date
233-099b M1DSbc (12/01)
Fax 1t9 requests to Collections, 608-240-7601; others to Account Processing; 608-240-7605
EFTA01700963
A/P Tracking Number:-
Metavante Corporation
Credit Card Services
Account N
-
Name:
Street Address
City
Business Name:
bes., LLC
State
ZIP
Collections
O Restrict Account — R9
El Zero Cards to Reissue
O List on Exception File
O Restrict on ATM Access
O Stop Interest
O Stop Late Charge
.O Stop Statements
O Stop Overlimit / Past Due Notices
O Minimum Payment Due This Cycle
O Fix Payment
$
O Re-Age account
O Erase Past Due Status
O 31-60
# times
K 91-120
# times
O Remove R9 Restrictions
ID 1-30
K 61-90 # times
O Erase All
S
# times
Free Text Messages/Miscellaneous Instructions
Financial Institution Name:
Authorized Signature:
Print Name:
For Metavante Use Only
Monetary Changes
5:Limit Increase to
O Limit Decrease to
O Change Corporate Account Limit to
O Reverse Finance Charge of
O Reverse Late Charge Fee of
O Reverse Over Limit fce of
K Reverse Insurance Fee of
$
$
O Reverse Current Membership Fee
El Waive Membership Fee Permanently
O Reverse Replacement Card Fee
$
O Reverse Convenience Fee
O Reverse NSF Fee
K Reverse Insurance Premium Fee
S
O Reverse Returned Check Fee
$
Date:
—/a/
if) -2.
Agent #
Telephone #
Ext.
Completed by
Verification
Date
Date
233-099b MIDSbc (I2/01)
Fax R9 requests to Collections, 608-240-7601; others to Account Processing, 608-240-7605
EFTA01700964
01/24/02
16:11
ID=PALM BEACH NATIONAL BARK
MODE
TX
BOX GROUP
511
DATE/TIME
TIME
PAGES
RPqIT
ERROR PASS
S.CODE
01/24 16:11 00'29" M8,1 APPLICATIONS
001/001 OK
0200
TracWu; Number
Metavante Corporation
Credit Card Services
Account Record, Card, PIN
Acct #
Name
Business Name
CS (..L.
Account Record Changes
X
Close Account
K Cards Returned
Cards Not Returned
K Re•Open Account K Remove Reissue Block
K Acid Soc. Sec. #:
K Add Telephone # K Home
K Business
0 Name Change
From:
To:
K Address Change to
City, State, ZIP
K Add Cardholder
K Order Card
K Delete Cardholder
K Add Authorized User
K Order Card
K Do Nor Order Card
K Delete Authorized User
K Add Credit Rating
K Delete Credit Rating
K Add Type Code
K Delete Type Code -
K Add Automatic Payment Deduction
T/R#
Checking Accra
K Minimum payment
K Previous balance
K Delete Automatic Payment Deduction
K Add E-mail Address
K Add Mother's Maiden Name
K Add Secondary CH SS#
K Add Secondary CH DOB
K Add Secondary CH Daytime Phone
K Do Not Order Card
For Marltal.Property States Only
K Married
K Not Married
K Legally Separated
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
K Order New Card for
Must mark below to indicate the type 0.1'4=1 ordered
Send Card:
K Normal Delivery — 7 to 10 days
K Express Delivery — 2 days (S10.00 charge)
K Saturday Delivery (Add $10.00)
K Eastcard —1 day ($20.00 charge)
K Saturday Delivery (Add $10.00)
Charge:
K Cardholder
K Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
Charge Cardholder Replacement Card Fee of $
PIN Issuance
K Order PIN Reminder
K PIN Federal Express — 3 days ($10.00 charge)
Charge:
K Cardholder
K Financial Institution
K Send PIN to Alternate Address Below
Name
Street Address
City, State, ZIP
Balance / Payment Transfers
EFTA01700965
pa Qj ecry?.S
A/P Tracking Number'
Metavante Corporation
Credit Card Services
Account Record, Card, PIN
Acct # ■
Name
Easiness Name /1/e-S, LL c •
Account Record Changes
54
Close Account
O Cards Returned
Cards Not Returned
O Re-Open Account
K Remove Reissue Block
O Add Soc. Sec. #:
O Add Telephone #
O Home
O Business
O Name Change
From:
To:
D Address Change to
City, State, ZIP
O Add Cardholder
O Order Card
K Do Not Order Card
K Delete Cardholder
D Add Authorized User
o Order Card
0 Do Not Order Card
O Delete Authorized User
O Add Credit Rating
O Delete Credit Rating
O Add Type Code
O Delete Type Code
O Add Automatic Payment Deduction
T/R#
Checking Acct#
El Minimum payment
El Previous balance
O Delete Automatic Payment Deduction
O Add E-mail Address
O Add Mother's Maiden Name
O Add Secondary CH SS#
K Add Secondary CH DOB
O Add Secondary CH Daytime Phone
O Add Fax Number
ID Add Cell Phone#
El Add Pager Number
O Privacy Option
Insurance
O Add Insurance
ci Delete Insurance
• If adding insurance, attach a signed copy of the insurance application
Free Text Messages/Miscellaneous Instructions
Financial Institution N
Authorized Signature:
Print Name:
233.0991 MIDSbe (1
Fax to Account Processing, 608-240-7605
For Marital Property States Only
0 Married
O Not Married
O Legally Separated
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
K Order New Card for
Must mark below to indicate the type of card ordered
Send Card:
O Normal Delivery — 7 to 10 days
El Express Delivery —.2 days (S10.00 charge)
O Saturday Delivery (Add 510.00)
K Fastcard — 1 day (520.00 charge)
O Saturday Delivery (Add 510.00)
Charge:
O Cardholder
O Financial Institution
Address to Mail Card:
Name
Street Address
Ciry,. ST, ZIP
K Charge Cardholder Replacement Card Fee of S
PIN Issuance
ID Order PIN Reminder
O PIN Federal Express — 3 days (510.00 charge)
Charge:
O Cardholder
O Financial Institution
El 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
O Send Convenience Checks — # of books
Name
Street Address
City, State, ZIP
Date:
Bank #
A cot #
Telephone:
Ext.
EFTA01700966
A/P Tracking Number:"
Metavante Corporation
Credit Card Services
Account Record, Card, PIN
Account Record Changes
0 Close Account
0 Cards Returned
0 Cards Not Returned
0 Re-Open Account
0 Remove Reissue Block
0 Add Soc. Sec. #:
El Add Telephone #
0 Home
0 Business
El Name Change
From:
To:
0 Address Change to
City, State, ZIP
0 Add Cardholder
El Order Card
0 Do Not Order Card
0 Delete Cardholder
0 Add Authorized User
0 Order Card
0 Do Not Order Card
0 Delete Authorized User
0 Add Credit Rating
0 Delete Credit Rating
0 Add Type Code
0 Delete Type Code
0 Add Automatic Payment Deduction
T/R#
Checking Acctit
K Minimum payment
El Previous balance
0 Delete Automatic Payment Deduction
0 Add E-mail Address
0 Add Mother's Maiden Name
0 Add Secondary CH SS#
0 Add Secondary CH DOB
0 Add Secondary CH Daytime Phone
0 Add Fax Number
0 Add Cell Phone#
0 Add Pager Number
0 Privacy Option
Insurance
0 Add Insurance
0 Delete Insurance
• If adding insurance, attach a signed copy of the insurance application
Free Te
Messages/Miscellaneous Instructions
D
Pre/
—
St7 A
i4v7te.4,
p
°79
dcl-
0.F ; 71 ;1 —.
Financial InstiturionName:
Authorized Signa
Print Name:
233-099a MIDSte
Fax to Account Processing, 608-240-7605
For Marital Property States Only
El Married
0 Not Married
0 Legally Separated
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
0 Order New Card for
Must mark below to indicate the type of card ordered
Send Card:
0 Normal Delivery — 7 to 10 days
0 Express Delivery — 2 days ($10.00 charge)
El Saturday Delivery (Add $10.00)
0 Fastcard — I day ($20.00 charge)
0 Saturday Delivery (Add $10.00)
Charge:
0 Cardholder
0 Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
0 Charge Cardholder Replacement Card Fee of $
PIN Issuance
0 Order PIN Reminder
0 PIN Federal Express — 3 days ($10.00 charge)
Charge: 0 Cardholder
0 Financial Institution
0 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
0 Send Convenience Checks — # of books
Name
Street Address
City, State, ZIP
Bank # /6-6 -
9
Telephone:
Date:
— r -O
Agent #
EFTA01700967
TCSI 001 CODE IGB ACCT
CYCLE 16 AGENT 1534 T1
BALANCE
10258.26 LIMP._ $25000 AVAILABLE
$1317 _;PAYMENT DUE
424.00
PAST DUE #
1
0
0
0
0
0
0
PAST DUE
$0
0 101601 00
PAST DUE $
0
0
0
0
0
0
0 VISAPHONE I
OPENED 9999 082101 HIGH BALANCE
$23966 120401 STATEMENTS
5 0 011602
000000 OVERLIMIT
0
$0 PAYMENT DUE DATE 021002
LIMIT HISTORY
$25000 2
(2500) 7371 1201 M MAINT 121001 PRIOR MAINT 1206(
ISSUE 1559 BRANCH 0000 DOB 000000 INS N 00
0 CIT N 000000
101'601
0
DISPUTE N 000000
.00
0000
0000 A:
TRANSFER
RCL N
CAB N
CR BUR 000000
N
N'N
CREDIT DATA 0801 0000 0000 9008 FIRST USE R 09070]
CARDS
0
0 1249 N VISA CARD REQUEST 000000 ENCODE Y PIN REQUEST N 000000
UM1 > N UM2 > N • OD COV N ANN FEE N
0000
.00 AUTO DEDUCTION
UDATA >
>
>
>
>
> 67108000000000
,CHECKING
SAVINGS
TRANSIT/ROUTING 000000000 OTHER CARDHOLDER
PAYMENT 011602
1676.46 CREDIT 011502 PURCHASE 012302 CASH ADVANCE 000000
1;11 NES LLC
**CORPORATE BILL - CORPORATE ACCOUNT
N2 CORPORATE ACCOUNT
Al 457 MADISON AVE FL 4
A2
CS NEW YORK NY
10022
**OLD
H 0000000000 B
HOLD N 00
**ACCOUNT IS CURRENT
cc
C7
U
C.:
EFTA01700968
TCSI 002 CODE TAL ACCT
NES LLC
-BUSINESS-
4470115340005213 NEj-1LC
1534
1534
TBR NES LLC
1534
TBR
4470115340005247
1534
TBR
1534
TBR
1534
TBR
4470110000002634
2534
TBR
'2534
TBR
4470115340005643
• 3534
TBR
NES LLC
NES LLC
NES LLC
NES LLC
3534
V4 TBR NEW YORK BAR AND GRILL
457 MADISON AVE FL 4
NEW YORK NY
NEW YORK NY
NEW
-NEW YORK NY
NEW YORK NY
NEW YORK NY
1001 10TH CT
JUPITER FL
KISSIMMEE FL
12189 US HIGHWAY 1
000-00-000
10022-6843
000-00-000
10021-4102
000-00-000
10021-4102
000-00-000
10021-4102
000-00-000
10022-6843
000-00-000
10022-6843
000-00-000
33477-9030
000-00-000
34746-3651
000-00-000
33408-2684
000-00-000
33408-2684
PF7/PA1=PAGE BACK PF8/ENTER=PAGE FORWARD
EFTA01700969
BANK 534 COST. #
COST NAME
STATUS
DATE OPENED
DATE CLOSED
BRANCH
COST CENTER
BNK APPL
534 CC
-
534 DP
534 DP
534 DP
534 DP
534 DP
-
534 DP
534 HH
CIC3209 - P
00000002550
457 MADISON AVE 4TH FL
NEW YORK NY 10020
OPEN
TAX ID
03-08-1991
HOME PHONE
BUS PHONE
PRIM OFFICER
•
SEC OFFICER
•
BIRTH
O 11-98 P
O 03-91 P
O 03-91 P
O 01-94 P
O 10-97 P
O 01-01 S
O 08-99 P
O 09-00 P HH RELATE
0000200
NEXT -
PAGE
1
03/29/02 08:48:47
REMARKS
HISTORICAL INFO
DOROTHY WILSON
DOROTHY WILSON
BALANCE SRA
AUTH SIGN
492
SOLE OWNE N 015
4,797 N *
SOLE OWNE N 015
44,333 N *
SOLE OWNE M 014.
618,204 N *
SOLE OWNE N 015
4,814 N *
AUTH SIGN D 075
26,741 N *
SOLE OWNS C 028
113,910 N *
EFTA01700970
AR Tracking NuinFii::
Metavante Corporation
Credit Card Services
Account Record, Card, PIN
Acct #
Name
1'4 G
Business Name
Account Record Changes
K Close Account
K Cards Returned
El Cards Not Returned
O Re-Open Account
K Remove Reissue Block
O Add Soc. Sec. #:
O Add Telephone #
O Home
K Business
O Name Change
From:
To:
O Address Change to
City, State, ZIP
O Add Cardholder
O Order Card
K Do Not Order Card
O Delete Cardholder
O Add Authorized User
O Order Card
O Do Not Order Card
O Delete Authorized User
El Add Credit Rating
O Delete Credit Rating
K Add Type Code
El Delete Type Code
K Add Automatic Payment Deduction
17R#
Checking Acedi
El Minimum payment
ID Previous balance
O Delete Automatic Payment Deduction
O Add E-mail Address
O Add Mother's Maiden Name
O Add Secondary CH SS#
El Add Secondary CH DOB
O Add Secondary CH Daytime Phone
O Add Fax Number
O Add Cell Phone#
O Add Pager Number
O Privacy Option
Insurance
O Add Insurance
O Delete Insurance
• If adding insurance, attach a signed copy of the insurance application
Free Text Meisages/Miscellaneous Instructions
5 1,42-1-
4%-•?-1/4
a_t;
Financial Institution Name:
Authorized Signature:
Print Name:
213-0992 MIDSbc
Fax to Account Processing, 608-240-7605
For Marital Property States Only
O Married
O Not Married
O Legally Separated
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
K Order New Card for
Must mark below to indicate she type of card ordered
Send Card:
K Normal Delivery — 7 to 10 days
O Express Delivery — 2 days ($10.00 charge)
K Saturday Delivery (Add 510.00)
K Fastcard —1 day ($20.00 charge)
K Saturday Delivery (Add 410.00)
Charge:
O Cardholder
K Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
K Charge Cardholder Replacement Card Fee of S
PIN Issuance
O Order PIN Reminder
O PIN Federal Express — 3 days (410.00 charge)
Charge: • O Cardholder
O Financial Institution
K Send PIN to Alternate Address Below
Name
Street Address
City, State, ZIP
Balance Payment Transfers
Transfer balance of S
From account #
To account #
Transfer payment of S
From account #
To account #
Convenience Checks
El Send Convenience Checks —
Name
Street Address
City, State, ZIP
Bank #
Telephone:
# of books
Aeent #
Ext.
EFTA01700971
A/P Tracking Numb/it-E.
Metavante Corporation
Credit Card Services
Acct #
Name
Business Name
Account Record Changes
O Close Account
O Cards hemmed
O Cards Not Returned
O Re-Open Account
O Remove Reissue Block
0 Add Soc. Sec. #:
O Add Telephone #
O Home
O Business
O Name Change
From:
To:
'Address Change to AIS
/2/
Pl y Had ISnAi f-Ve.
City, State, ZIP
-e
()
Lk
A) Y / O 0
ID Add Cardholder
O Order Card
O Do Not Order Card
O Delete Cardholder
O Add Authorized User
El Order Card
O Do Not Order Card
O Delete Authorized User
O Add Credit Rating
Delete Credit Rating
O Add Type Code
O Delete Type Code
O Add Automatic Payment Deduction
T/R#
Checking Acct#
O Minimum payment
O Previous balance
O Delete Automatic Payment Deduction
O Add E-mail Address
O Add Mother's Maiden Name
O Add Secondary CH SS#
O Add Secondary CH DOB
O Add Secondary CH Daytime Phone
O Add.Fax Number
O Add Cell Phone#
O Add Pager Number
O Privacy Option
Insurance
O Add Insurance
O Delete Insurance
• If adding insurance, attach a signed copy of the insurance application
re£~ext Messages/Miscellaneous Instructions
Financial Instinnion Na
Authorized Signa
Print Name:
233-0993 Mlinee (12,0
Fax to Account Processing, 608-240-7605
Account Record, Card, PIN
For Marital Property States Only
O Married
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
O Order New Card for
O Not Married
O Legally Separated
Must mark below to indicate the type of eard ordered
Send Card:
O Normal Delivery — 7 a; 10 days
O Express Delivery— 2 days ($10.00 charge)
O Saturday Delivery (Add $10.00)
K Fastcard — 1 day ($20.00 charge)
O Saturday Delivery (Add $10.00)
Charge:
O Cardholder
O Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
O Charge Cardholder Replacement Card Fee of S
PIN Issuance
O Order PIN Reminder
O PIN Federal Express — 3 days ($10.00 charge)
Charge:
D Cardholder
O Financial Institution
O 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
O Send Convenience Checks — # of books
Name
Street Address
City, State, ZIP
Bank #
Telephone.
Date:
/ -
Ext.
EFTA01700972
AR Tracking Number:
[
Metavante Corporation.
Credit Card Services
Account Number:
Name:
Street Address
City
Business Name:
Peg,
State
ZIP
Collections
O Restrict Account —129
O Zero Cards to Reissue
O List on Exception File
O Restrict on ATM Access
O Stop Interest
D Stop Late Charge
K Stop Statements
O Stop Overlimit / Past Due Notices
K Minimum Payment Due This Cycle
S
K Fix Payment
S
O Re-Age account
O Erase Past Due Status D 1-30
# times
O 31-60
# times
O 61-90 # times
O 91-120
# times i
O Erase All
O Remove R.9 Restrictions
Free Text Messages/Miscellaneous Instructions
Financial Institution N
Authorized Signature:
Print Name:
Moneta
Chan es
it Limit Increase to
O Limit Decrease to
' Don •
S
O Change Corporate Account Limit to
O Reverse Finance Charge of
O Reverse Late Charge Fee of
O Reverse Over Limit fee of
O Reverse Insurance Fee of
For Metavante Use Only
S
O Reverse Current Membership Fee
O Waive Membership Fee Permanently
D Reverse Replacement Card Fee
K Reverse Convenience Fee
K Reverse NSF Fee
K Reverse Insurance Premium Fee
D Reverse Returned Check Fee
Telephone
S
S
Agent i
Ext
Completed by
Verification
Date
Date
233-099b MlDSbc (1MI)
Fax R9 requests to Collections, 608-240-7601; others to Account Processing, 608-240-7605
EFTA01700973
MP Tracking Number:
Metavante Corporation
Credit Card Services
Account Record, Card, PIN
Account Record Changes
K Close Account
K Cards Returned
K Cards Not Returned
K Re-Open Account
K Remove Reissue.Block
K Add Soc. Sec. #:
K Add Telephone # K Home
K Business
K Name Change
Front
To:
K Address Change to
City, State, ZIP
K Add Cardholder
K Order Card
K Do Not Order Card
K Delete Cardholder
K Add Authorized User
K Order Ctird
K Do Not Order Card
K Delete Authorized User
K Add Credit Rating
Delete Credit Rating
K Add Type Code
K Delete Type Code -
K Add Automatic Payment Deduction
T/R#
Checking Acct#
K Minimum payment
K Previous balance
K Delete Automatic Payment Deduction
K Add E-mail Address
K Add Mother's Maiden Name
K Add Secondary CH SS#
K Add Secondary CH DOB
K Add Secondary CH Daytime Phone
K Add Fax Number
K Add Cell Phone#
K Add Pager Number
K Privacy Option
Insurance
K Add Insurance
K Delete Insurance
• If adding insurance, attach a signed copy of the insurance application
Free Text
essages/Miscellane
Instructions
Financial Institution Name:
Authorized Sig
Print Name:
213-099a MIDSbc (i
Fax to Account Processing, 608-240-7605
For Marital Property States Only
K Married
K Not Married
K Legally Separated
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
K Order New Card for
Must mark below to indicate the type of card ordered
Send Card:
K Normal Delivery — 7 to 10 days
0 Express Delivery— 2 days (S10.00 charge)
K Saturday Delivery (Add S10.00)
K Fastcard —1 day ($20.00 charge)
K Saturday Delivery (Add $10.00)
Charge:
K Cardholder
K Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
K Charge Cardholder Replacement Card Fee of S
PIN Issuance
K Order PIN Reminder
K PIN Federal Express — 3 days (S10.00 charge)
Charge:
K Cardholder
K Financial Institution
K Send PIN to Alternate Address Below
Name
Street Address
City, State, ZIP
Balance,/ Payment Transfers
Transfer balance of S
From account #
To account #
Transfer payment of S
From account #
To account #
Convenience Checks
K Send Convenience Checks — # of books
Name
Street Address
City, State, ZIP
Bank #
Telephone
EFTA01700974
A.P •Mehl
Nuamboes
hintamrsarstet
Corporation
Credit
Card
Sermeinnat
"neaten
hi
rrsens•
Serves Address
Gine
Dustneas Name:
011ection5
Moneta
Chian
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Inaretne
to
S
T
0
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Rescrict Account
R9
=
Pare Caren to Reterus
]Sat en Ran:papa
File
Restrict on ATM Access
=
Stop Interest
i=1 Stop Late Charge
Stop Statements
CI
Stop Overlimit
f Pass Cue Haricot
MinannumThyrneac
Due This Cycle
C Fix Payment
3
Re -Age account
Erase Past Cue Stems
CI 31-60
0 Once
91-120
0 nines
(=Remove
110 ittaterictione
fl
ee Text
9/SessateM/TvliscallnocOuS
inSternetIcsizs
,
0
S Times
rn a i_00 M fa—
(-n
All
Sane
CI
Limit neonate
to
Change
Corporate
Ac Count Limit to
CI
Reverse
Finance
Orange of
Reverse
Late Charge Pee of
Reverse
Over Limit fee of
Reverse
Insurance
Fee er
3
S
=
Reverse
Current Membership
Tao
In
Waive Memberstdp
Pee Permanently
CI
Reverse
Replacement
Card Pee
5
Reverse
Convenience
Pee
Reverse
NSF Fee
O
Reverse
Insure Me Premium
Poe
S
Reverse
Renamed
Cheats Pee
S
Pineataial Xametinadon Hemel
Authorized
Sips.
--..
Print Hinnen
Per Metevarite
Viso OnlV
Completed
by
Wrifiean
on
Date
Cate
Cain
Agent e
Int
Fax
X2.9 requests
to
Collections.
608-240-7601;
others
to
Account
Processing,
608-240-7605
***
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EFTA01700975
Code:
Date:
Keyed by:
A/P Trackin Number:
M &I Data Services
EFD Card Services
Please indicate Couunncial Curd Product type:
0
VISA
usfness
■
CI MasterCard
Cor orate
0
Pureliaan.
Corn an Name:
SECTION I— AUTHORIZED USERS
Corn an Number:
Co •rate Account:
•
Name
Cmilit
Cash Advance Capability 1
Reporting Unit (Optional)
General Ledger It
Taxable
MEA
Line
S i nbt)i
"IP" or %of Limit
Pin Y/N
Div. II)
Div. Name
Dept. ID Dept. Name
Assigned •
Y/N •
Y/N•
lot ere
al en arm pr ona
• Social Security Number
'(Optional)
Nome telephone II (Optional)
(
)
Account Number (EFD Use)
Cardholder billing address
j
City
State
ZIP ('ode
Special dandling Intinutions•
0
Finked INuess
Plastic address if differs:6i from cardholder
Name
billing address:
Credit
Line
Cash Advance Capability t
"D" or % &limit
Pin Y/N
Div. If)
Div.
City
Reporting Unit (Optional)
Name
Dept. If) Dept.
Mate
Name
Zll' Code
.. -.... .......... --.......--.....
General Ledgers
Taxable
Assigned •
Y/N•
--.—.—
MLA
Y/N•
Mothers Maiden Name (Optional)
Social Security Number
(Optional)
I tome telephone It (Optional)
(
)
Account Number (EFD Use)
Cardholder billing address
City
State
ZIP Code
Special Dandling Instructions:
0
bcdcral lixiiiess
Plaids address if differeal from Cardholder
Name
billing address:
Credit
Line
Cash Advance Capability t
"D" or % of l.imit
Pin Y/N
Div. If)
Div.
City
Reporting Unit (Optional)
Name
Dept. ID Dept.
Stale
Name
Zll' Code
General Ledger a
Assigned •
Taxable
Y/N•
MEA
Y/N•
Mothers Maiden Name (Optioned)
Social Security Number
(Optional)
Nome telephone a (Optional)
(
)
Account Number (EFD Use)
Cardholder billing address
I City
Stale
ZIP Code
Special Handling lostrudions.
0
Federal Express
Plastic address if different from Cardholder billing address:
City
Stale
ZIP Code
• Visa Purchasing Card Options
Financial Institution Name:
Authorized Signature:
t V- Yet
asDefaidt to Company Scrimp (styes, indicate % of limit available for cash)
Agent It
Date:
Dank I/
/57-9
233-107 MIDShe (04/00
EFTA01700976
AR Tracking Nuiii—be
r:
Metavante Corporation
Credit Card Services
Collections
Monetary Changes
K Restrict Account — R9
0 Zero Cards to Reissue
0 List on Exception File
K Restrict on ATM Access
D Stop Interest
O Stop Late Charge
D Stop Statements
K Stop Overlimit / Past Due Notices
El Minimum Payment Due This Cycle
S
El Fix Payment
S
K Re-Age account
0 Erase Past Due Status
El I-30
0 31-60
# times
El 61-90
K 91-120
# times
0 Remove R9 Restrictions
# times
# times
0 'Erase All
Free Text Messages/Miscellaneous Instructions
unit Increase to
S 07'00t)
K Limit Decrease to
S
El Change Corporate Account Limit to
0 Reverse Finance Charge of
K Reverse Late Charge Fee of
D Reverse Over Limit fee of
CI Reverse Insurance Fee of
O Reverse Current Membership Fee
K Waive Membership Fee Permanently
D Reverse Replacement Card Fee
0 Reverse Convenience Fee
0 Reverse NSF Fee
0 Reverse Insurance Premium Fee
El Reverse Returned Check Fee
$
Financial Institution Name:
Authorized Sigiatur
Print Name:
For Metavante Use Only
Completed by
Verification
Date
Date
Date:
/SS c Agent #
Ext.
233-099b MIDSbc (12101)
Fax R9 requests to Collections, 608-240-7601; others. to Account Processing, 608-240-7605
EFTA01700977
Account Record Changes
Metavante Corporation
Credit
ervices
A/P Tracking Number:
Account Record, Card, PIN
Close Account
K Cards Returned
Cards Not Returned
CI Re-Open Account
O R mo e Reissue Block
K Add Soc. Sec. #:
K Add Telephone # O Home
O Business
K Name Change
From:
To:
1:1 Address Change to
City, State, ZIP
K Add Cardholder
K Order Card
O Do Not Order Card
O Delete Cardholder
O Add Authorized User
O Order Card
O Do Not Order Card
O Delete Authorized User
1:1 Add Credit Rating
O Delete Credit Rating
O Add Type Code
O Delete Type Code
CI Add Automatic Payment Deduction
T/R#
Cheeping Acct#
O Minimum payment
0 Previous balance
CI Delete Automatic Payment Deduction
O Add E-mail Address
CI Add Mother's Maiden Name
O Add Secondary CH SS#
O Add Secondary CH DOB
CI Add Secondary CH Daytime Phone
El Add Fax Number
O Add Cell Phone#
O Add Pager Number
CI Privacy Option
Insurance
O Add Insurance
O Delete Insurance
• If adding insurance, attach a signed copy of the insurance application
Free Text Messages/Miscellaneous Instructions
Financial Institution Nam
Authorized Signa
Print Name:
233-0992 MIDSbc (12/01)
Fax to Account Processing, 608-240-7605
For Marital Property States Only
O Married
O Not Married
O Legally Separated
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
O Order New Card for
Must mark below to indicate the type of card ordered
Send Card:
K Normal Delivery — 7 to 10 days
O Express Delivery-2 days ($10.00 charge)
K Saturday Delivery (Add $10.00)
O Fastcard — 1 day ($20.00 charge)
O Saturday Delivery (Add $10.00)
Charge:
O Cardholder
O Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
O Charge Cardholder Replacement Card Fee of $
PIN Issuance
o Order PIN Reminder
O PIN Federal Express — 3 days (S10.00 charge)
Charge:
O Cardholder
O Financial Institution
CI 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 S
From account #
To account #
Convenience Checks
O Send Convenience Checks — It of books
Name.
Street Address
City.. State. ZIP
Bank #
Telephone:
(LS k
Date:
A ent #
Ext.
EFTA01700978
Code:
(late:
Keyed by:
A/P Trackin Number:
MM Data Services
EFD Card Services
Please indicate Co !!!!!! crcial Card Product type:
_Company NallIC: pe $ /
SECTION I — AUTHORliED USERS
Business
O MasterCard
O Corporate
Company Hunker
Corporate Account:
O Purls
Credit
Line
tte
Cash Advance Capabilit
"D" • % or Limit
I'i Y
Div. II)
Div. Name
Reporting Unit (Optional)
Dept. ID Dept. Name
Gencial Ledga N
Assigned •
Taxable
Vite•
MCA
Y/N•
M
•
Social Security Number
'(optional)
Home telephone n (Optional)
(
)
Account Number (RFD Use)
. .Wielder billing address
City
Slate
Zll' Code
Special Handling I nstriscui 0000 s:
el IkNIti al FAN
s.
Plastic address if different from Cardholder billing address:
Ctedit
Cash Advance Capabili t
tine
"O" or % of Limit
I'
DO.
/OD g(ta
City
Div. ID : Div. Name
Slate
Reporting Unit (Optional)
Derd. ID Dept. Name
ZIP Utak
Cameral Ledger N
Taxable
MI:A
Assigned •
'ON •
VFW
Social Security Number
(Optional)
home telephone II (Optional)
(
)
Account Number (EFD Use)
Cardholder billing address
City
State
ZIP Code
Special Handling Instructions:
• ltdetal I:apte.,.<
Plastic address if different from Cardholder
etnnfre
billing address:
Credit
line
Cash Advance Capability t
"On or %of Limit
Pin Y/N
Div-ID
Div.
City
Name
Slate
Reporting Unit (Optional)
Dept. ID Dept. Name
ZIP Code
General Ledger N
Taxable
MEA
Assigned •
Y/N •
Yfft•
Mothers Maiden Manic (Optional)
Social Security Number
(Optional)
Home telephone It (Optional)
(
)
Account Number (EFD Use)
Cardholder billing address
City
State
ZIP Code
Special Handling Instructions:
• Federal Express
Plastic address if different Beat Cardholder billing address:
City
State
ZIP Code
• net Purchasing Card Options
Financial Institution Name:
Authorized Signature:
t
=Yes.
nelo.
••
au Ito Caarpasty et-up
yes, indicate orb ofIint asnlla
Agent A
Bank fl
Date:
-ff -
233-107 MIDShc (04/00)
EFTA01700979
A)? Tracking Number:
Metavante Corporation
Credit Card Services
Account N
Name:
Street Address
City
AI i,„/
Business Name:
IVL
L L C
Collections
Dv/.
K Restrict Account - R9
O Close Account — V9
O Delete Cardholder
O Zero Cards to Reissue
O List on Exception File
O Restrict on ATM Access
O Stop Interest
O Stop Late Charge
O Stop Statements
O Stop Overlirnit / Past Due Notices
U Minimum Payment Due This Cycle
O Fix Payment S
O Re-Age account
O Erase Past Due Status
El 31-60
ear times
O
91-120
# limes
El Remove R9 Restrictions
O 1-30
# times
O 61-90
tt times
O Erase All
Free Text Messages/Miscellaneous Instructions
Financial Institution Name:
Authorized Signature:
Print
Name:
For Metavante Use Only
Completed by
Verification
loo r
State
ZIP
Monetary Changes
1 00?
O
knit Increase to
I
Limit Decrease to
O Change Corporate Account Limit to
S
O Reverse Finance Charge of
O Reverse Late Charge Fee of
O Reverse Over Limit fee of
O Reverse Insurance Fee of
O Reverse Current Membership Fee
O Waive Membership Fee Permanently
O Reverse Replacement Card Fee
O Reverse Convenience Fee
O Reverse NSF Fee
O Reverse Insurance Premium Fee
O Reverse Returned Check Fee
S
S
S
$
$
S
Date
Date
233.099b MIDSbc (12101)
Fax R9 requests to Collections, 608-240-7601; others to Account Processing, 608-240-7605
EFTA01700980
Vat..
nc rte U :
A/P Tracki
Number:
Metavante Corporation
Credit Card Services
Please indicate Commercial Card Product type; •
Company Name:
VE
.5
tee& C.-
SECTION I — AUTHORIZED'
Cl/ VISA
a
Rosiness
K
K
MasterCard
Corporate
Company Number:
O
Purchasin
Corporate Account:
Credit
Line
N606.
Cash Advance Capability lil
"D" or %of imit
Pin Y/N
0 o
Reporting Unit (Optional)
Div. ID
Div. Name
Dept. ID Dept. Narne
•
General ledger if
Assigned •
Taxable
Whit
MEA
Y/N•
o
rs
al en
ame
pt onat)
Social Security Number
(Optional)
Home telephone H (Optional)
Account Nun her (llfelayante Use)
Cardholder billing address
•
City
Slate
ZIP Code
Spt . liandling Instructions:
O Federal Express
Plastic address if different from Cardholder billing address:
Credit
Line
yo
Cash Advance Capability II
"D" or % of Limit
Pin Y
00
0
ft,
Div. ID
Div.
City
Reporting Unit (Optional)
Name
Dept. ID Dept.
Slate
Name
ZIP Code
General Ledger 0
Assigned •
Taxabk
Y/N•
MEA
TiN•
Social Security Number
(Optional)
Home telephone tt (Optional)
i
Account Number (Metavante Use)
:ardholder billing address
City
State
ZIP Code
;paint Handling Instructions.
-O Federal Express
'task address if different from Cardholde billing address:
City
State
ZIP Code
lame
)
Credit
Line
Cash Advance Capability ii
"V' or % of Limit
Pin YIN
Reporting Unit (Optional)
Div. ID
Div. Name
Dept. ID Dept. Name
General Ledger PI
Assigned •
Taxable
Y/N•
MEA
Y/N•
/others Maiden Name (Optional)
Social Security Number
(Optional)
Home telephone H (Optional)
)
Account Number (Herayante Use)
ardholder billing address
City
State
ZIP Code
'eclat Handling Instructions:
O Federal Express
astic address if different from Cardholder billing address:
City
.. .
., .. ..
State
,
ZIP Code
_. _
Visa Purchasing Card Options
naneial Institution Name: C010
ulhorizcd Signature:
Y=Yes: N=No. D=Dejautt to Conspany 3dt-up
yes. n scat
o
sin a
13 (-4 i(
3.107 MIDSbe (I1100)
Agent
Date:
Dank E
.5116 (I ) 3
EFTA01700981
Code:
Metavante Corporation
Credit Card Services
Please indicate Commercial Cad Naiad type:
Dale:
K edb
A/P Trac:Inc, Number
.
_
COMMERCIAL CARD.PRODUCTS INDIVIDUAL ACCOUNT INFORMATION'
-
Company Name:
/i) (E., 5
LA, c
SECTION I — AUTHORIZED USERS
Lit VISA
isushiess
K
;.I.isic:exti
Corporate
Company Number:
K
Por
:., 'n
Corporate Account:
Credit
Lin
3,poo
Cash Advance Capability N
"D" Ol % of Limit
Pin Y6I
Repotting Unit (Optional)
Div. II)
Div. Name
Dept. ID Dept. Name
Genet,' Ledger I
• Assigned°
Taxable
Whi•
MEA
Y/N•
Social Security Number
Home telephone II (Optional)
(Optional
)
Account Number (Metavante Use)
Cardholder billing address
City
Slate
ZIP Code
Special Handling Instructions:
0 Pcdcrat Express
Plastic address If different from Cardholder
Name
billing address:
I wthi
line
Cash Advance Capability AV
"D" or % of Limit
Pin WN
Div. ID
Div.
City
Reporting Unit (Optional)
Name
Dept. ID Dcpl.
State
Name
ZIP Code
i
General Ledger ll
Assigned •
Taxable
Y/N•
MEA
Y/t4*
Mothers Maiden Name (Optional)
Social See rity Number
(Optional)
Home telephone II (Optional)
)
Account Number (Aletnante Use)
•
Cardholder billing address
City
State
ZIP Code
Spedal Handling instructions:
U Federal Express
Plastic address if different from Cardholder billing address:
I City
Statc
ZIP Code
Name
Credit
Line
Cash Advance Capability ft
"D" or % of Limit
Pin Y/N
Reporting Unit (Optional)
Div. ID
Div. Name .
Dept. II) Dept. Name
General Ledger a
Assigned •
Taxable
171i•
M EA
ION*
Mothers Maiden Name(Optional)
Social Security Number
(Optional)
Home telephone N (Optional)
)
Account Number (Metavante Use)
Cardholder billing address
City
State
ZIP Code
Special Handling inflections'
0
Federal Express
Plastic address if different from Cardholder billing address:
City
Slate
ZIP Code
• Visa Purchasing Card Options
Financial Institution Name:
Authorized Signature:
0Y=Yes. N=No, D=Defauft to Company Set-up (if yes. indicate % of limit available for cash)
••••••
• ••• a•enco, r I IiOQ)
Agent N
Dale:
Hanky
EFTA01700982
Code:
Metavante Corporation
Credit Card Services
Please indicate Commercial Card Product type:
Date:
K ed b
Company Name: NI ES L
SECTION I— AUTHORISED USERS
AIP Trackin Number:
--COMMERCIAL CARD PRODUCTS INDIVIDUAL ACCOUNT INFORMATION
VISA
Rusines
O
MasterCard
O Corporate
Company Number:
Purchasin
Corporate Account:
. .
Credit
Line
3OOO
Cash Advance Capability II
"D" or %of Limit
Pin VIN
O CA 0
/4
Reporting Unit (Optional)
Div. ID
Div. Name
Dept. ID Dept. Name
General Ledgers
Assigned •
Taxable
WTI'
MEA
Vaq•
Mothers Maiden Name (Optional)
Social Security Number
(Optional)
Home telephone fl (Optional)
(
)
Account Number (lletavante Use)
rdholder billing address
City
State
ZIP Code
Special Handling Instruclions:
0 Federal Express
Plastic address if different from Cardholder billing address:
City
State
ZIP Code
Name
Credit
Line
Cash Advance Cape/Ably lii
"D" or % of Limit
Pin YM
Reporting Unit (Optional)
Div. ID
Div. Name
Dept. ID Dept. Nanx
General Ledgers
Assigned •
Taxable
NIN•
M EA
V/N•
Mothers Maiden Name (Optional)
Social Security Number
(Optional)
Home telephone tr (Optional)
)
Account Number (Metavante Use)
Cardholder billing address
I City
State
I ZIP Code
Special Handling Instructions:
0 Federal Express
Plastic address if different from Cardholde billing address:
City
State
ZIP Code
. . ..._._
Name
Credit
Line
Cash Advance Capability S
'D" or %of Limit
Pin VIN
Reporting Unit (Optional)
Div. ID
Div. Name
Dept. ID Dept. Name
General Ledgers
Assigned •
'Iambic
YIN•
MEA
Wei*
Mothers Maiden Name (Optional)
Social Security Number
(Optional)
Home telephone II (Optional)
)
Account Number (Metavante Use)
Cardholder billing address
City
State
ZIP Code
Special Handling Instructions:
U Federal Express
Plastic address if different from Cardholder billing address:
City
State
ZIP Code
• Visa Purchasing Card Options
Financial Institution Name: Z.O Lo IO 1 AL. C A k-
Agent «
Bank tl
Authorized Signature:
Date:
\*• \‘.1\ ky
233-107 MIDSbe (I 1/00)
N-No, D-,Default to Company Set-up Wye& indicate % of limit available for cash
EFTA01700983
illetavante Corporation
Credit Card Services
'lease indicate Commercial Card riOd1C IYPc:
:ompany Name:
ant4U
le kw.
VISA
Business
O
MasterCard
O
Corps/rate
Company Number:
K
Pur
Corporate Account:
Name
Alfre do
ROartSkiel
Credit
Linn
2p So0
Cash Advance Capability if
"D" w'/. of Limit
Pin YIN
Repotting Unit (Opiional)
Div. II)
Div. Name
Dept. ID Dept. Name
Gcncial Ledger it
Assigned •
Taxable
YIN'
M EA
lithl•
Mothers Maiden Name (Optional)
Social S
(Optional
Home telephone If (Optional)
(
)
Account Number (Mehtrante Use)
Cardholder billing address
Ii 5r 1 [Dad ) On /hie, FEW» h
f 10 Dr
City
Mk)
1( 0 r )(
Stale
Al
Y:
ZIP Code
) 6 O Dal
Special Handling Instructions:
U fedel ral Express '
Plastic address If different from Cardholder billing address:
City
Slate
ZIP Code
Name
Credit
Line
1r 00 0
Cash Advance Capability /0
"D" or %of Limit
Pin YIN
LBv..11)
Div.
Reporting Unit
Name
(Optional)
Dept. ID Dept. Name
General Ledger ti
Assigned •
Taxable
Y/N•
MEA
Y/N•
Molders Maiden Name (Optional)
Social Sec n
Dome telephone II (Optional)
(Optional)
i
)
Account Number (Metarante Use)
Cardholder billing address
.
5 /49 0 .? S
City
State
ZIP Code
Special Handling instructions.
O Federal Express
Plastic address if different from Cardholder billing address:
City
Slate
ZIP Code
Name
Cash Advance Capabilily k7
Reporting Unit (Optional)
General Ledger H
Taxable
MEA
itg-i - C1 0
Fonitnile,
Credit
Line
1, 000
"D" or
of Limit
Pin YIN
Div. ID
Div. Name
Dem. ID Dcpl. Name
Assigned •
YIN*
WM'
Mothers Maiden Name (Optional)
Social Sec
(Optional)
Home telephone P (Optional)
(
)
Account Number (Metarante Use)
Cardholder billing address
A
City
State
ZIP Code
Special Handling instructions:
Er Federal Express
Plastic address If different from Cardholder billing address:
City
State
I ZIP Code
• Visa Purchasing Card Options
Financial Institution Name: (0
(1,-
Authorized Signature:
233-107 MIDSbe (11/00)
Y= es,
o, D=Dejoulr10 CompanySet-up
,
Dank F 1_5-3 y
Date
Agent #91
ID v
O??
•
EFTA01700984
Code:
Date:
to a
C
0
to
C
ID
L
1—
*
Metavante Corporation
Credit Card Services
Pkasc indicate Cummercial Cant l'indtta type:
Company Name:
A/CS ,
C
SECTION I— AUTHORIZED USERS
commriciAL CARD PRODUCTS — INDIVIDUAL
VISA
liminess
K MasrnCard
O
airmen( e
o PureintsIn
Company Number:
Corporate Account
•
at.
Nave
lifi-e
c do
RoanqUeZ
Credit
Line
2,5 -00
Cash Advance Capability a
"D" or %of Lim!!
Pin Y/N
Reporting Unit (Opitorre0
Div. ID
Div. Name
Dept. ID DWI. Heine
j
Gam
A
Mothers Maiden Name (Optional)
•
Social Security Number
(Optional)
Home telephoned (Optional)
(
)
Account Number 0
Cardholder billing adds
(15 47 /licit 5 on 4 ve
/DIA it Plots
.
I State
/lbw York
At Y.
21!
Special Handling Instrualont
O Faiend Express
Vitale madras If different from Cardholder billing address..
City
State
il
Name
Credit
Lam
)1000
• Cash Advance Capability fil
IlY" of % of Limit
Piu YeN
Reporting Unit (Optioned/
Div. 1O
Div. Name
Dept. ID
Dept. Name
Mothers Maiden Na
Social Security Number
(Optional)
Home telephone V (OpaonaO
)
Account Number
Canilsoides billing address
-
5AM
C
City
Slate
Special. Handling Instructions:
O Federal Express
Plane address If different from Cardholde billing addness
City
Sure
Name
1.12Lic,r) 0
F0/11.C/IrlIC
Credit
Line
i 1 0O 0
Cash Advince Capability 0
"D" a % or Limit
Pin 'ON
Reporting Unit (Onion')
'
DIv.1O
Div. Name
Devi. ID 0H* Hanle
C
Mothers Malden Maine (Orminfia0
Social Sec '
Home telephone fl (Optiona0
(Op/tonal)
Account Numbe
(
)
Cardholder billing address
15ty
Stale
..S 4 M c
Special Handl:or Windfalls:
O Federal Express
•
Plank addren I( different from Cardholder billing address:
Oty
..
Stale
-
.
' Visa Purchasing Can't Options
Financial ineliertion Hama: COI H1{4
Authorized Signature:
233-107 MIDSbe (I IMO)
MY- Yu. NerNo, D=Defouft
onwany
I -Up
ns. I
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o
ova:
t
Areald
Bar
Date:
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EFTA01700985
EXCEPTION
TYPE
ACC()
Pa
DATE
USE
CARD
IS
C
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SUE
07-01-03
200 riER
CORES S
PAST DUE
Far ow. &ME
ustrins
s
.0 S
.00
000
I
I
PAST •
WIt:?.?
.. 00
DUE
IBM
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NEW YORK NY 10022-6843
AMOUNT
BY
• ,
lt:-.4b.
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HOME TELEPHONE
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OF
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, 00N DAYS
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08/03
tsar
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9
11111 1
7.4
Man litall
CREDIT LINE
NIVIEST mum DISPUTE
S
0s
7000
PURCHASES en. maim
PAYMENTS
CREWS
MOM untallt
OYEAUM IT
/•41:00k
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AMOUNT
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EFTA01700986
EXCEPTION
TYPc CARD
ACCO "fr NI tl !EIF R
DATE
USER NUMBER
umnu
Ud
07-01-0
M
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TOTAL DUE
PAST WE
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$
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457 MADISON AVE FL 4
MX
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NEW YORK NY 10022-6843
AMOUNT 44 4110'
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BY
RANGE .,.,. .....
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mast BA UM DISPUTE
SIXMONTHS MONETARYHISTORY '
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EFTA01700987
AN Tracking Number:
Metavante Corporation
Credit Card Services
Account Number:
Name:
Street Address
City
Business Name:
e.2
State
ZIP
Collections
K Restrict Account — R9
K Close Account — V9
K Delete Cardholder
K Zero Cards to Reissue
K List on Exception File
K Restrict on. ATM Access
K Stop Interest
K Stop Late Charge
K Stop Statements
K Stop Overlimit / Past Due Notices
K Minimum Payment Due This Cycle
.0 Fix Payment $
K Re-Age account
K Erase Past Due Status
K 31-60
# times
K 91-120
# times
K Remove R9 Restrictions
$
K 1-30
# times
K 61-90 # times
K Erase All
Free Text Messages/Miscellaneous Instructions
Financial Institution Name:
Authorized Signature:
Print
Name:
Completed by
Verification
For Metavante Use Ooly
Monetary Changes
alLimit Increase to
$ Lin OO •
K Limit Decrease to
K Change Corporate Account Limit to
K Reverse Finance Charge of
K Reverse Late Charge Fee of
K Reverse Over Limit fee of
K Reverse Insurance Fee of
K Reverse Current Membership Fee
K Waive Membership Fee Permanently
K Reverse Replacement Card Fee
K Reverse Convenience Fee
K Reverse NSF Fee
K Reverse Insurance Premium Fee
K Reverse Returned Check Fee
$
S
S
S .
$
Bank # 1,53-
Agent #
Telephone #
Ext.
Date
Date
233-0996 MIDSbc (12/00
Fax R9 requests to Collections, 608-240-7601; others to Account Processing, 608-240-7605
EFTA01700988
A/P Tracking Number:
Metavante Corporation
Credit Card Services
Name:
Street Address
City
Business Name:
Collections
Monetary Changes
K Restrict Account — R9
K Close Account — V9
K Delete Cardholder
O Zero Cards to Reissue
K List on Exception File
K Restrict on ATM Access
O Stop Interest
O Stop Late Charge
O Stop Statements
O Stop Overlirnit / Past Due Notices
O
Minimum Payment Due This Cycle
O Fix Payment $
K Re-Age account
K Erase Past Due Status
O 31-50
# times
O 91-120
# times
El Remove R9 Restrictions
K 1-30
O 61-90
O Erase All
$
# times
# times
Free Text Messages/Miscellaneous Instructions
Financial Institution Name:
Authorized Sign
Print
Name:
[Limit Increase to
O Limit Decrease to
.O Change Corporate Account Limit to $
O Reverse Finance Charge of
O Reverse Late Charge Fee of
K Reverse Over Limit fee of
K Reverse Insurance Fee of
O Reverse Current Membership Fee
O Waive Membership Fee Permanently
K Reverse Replacement Card Fee S
O Reverse Convenience Fee
O Reverse NSF Fee
D Reverse Insurance Premium Fee $
K Reverse Returned Check Fee
$ 67o00 •
S
S
$
For Metavante Use Only
Bank # /--g 9 Agent #
Ext.
Telephone #
Completed by
Verification
Date
Date
233.0996 MIOSbc (12/01)
Fax R9 requests to Collections, 608-240-7601; others to Account Processing, 608-240-7605
EFTA01700989
AT Tracking Number:
Metavante Corporation
Credit Card Services
Collections
Monetary Changes
O Restrict Account — R9
Close Account — V9
O Delete Cardholder
O Zero Cards to Reissue
O List on Exception File
O Restrict on ATM Access
O Stop Interest
Stop Late Charge
O Stop Statements
O Stop Overlimit / Past Due Notices
-D Minimum Payment Due This Cycle
Fix Payment $
O Re-Age account
O Erase Past Due Status
O 1-30
; o31-60
# times
K 91-120
# tirnes
j g Remove R9 Restrictions
# times
61-90
Erase All
# times
Free Text Messages/Miscellaneous Instructions
Financial Institution Name:
. Authorized Signature:
Print
Name:
For Metavante Use Only
Limit Increase to
O Limit Decrease to
O Change Corporate Account Limit to
O Reverse Finance Charge of
O Reverse Late Charge Fee of
O Reverse Over Limit fee of
O Reverse Insurance Fee of
O Reverse Current Membership Fee
O Waive Membership Fee Permanently
O Reverse Replacement Card Fee
K Reverse Convenience Fee
•
Reverse NSF Fee
O Reverse Insurance Premium Fee
K Reverse Returned Check Fee
$ ID, a oo •
$
$
$
$
phone #
Completed by
Verification
Date
Date
(12/01)
be
Fax R9 requests to Collections, 608-240-7601; others to Account Processing, 608-240-7605
EFTA01700990
MI' Tracking Number:
Metavante Corporation
Credit Card Services
Account Record, Card, PIN
Account Record Changes
Vie Account
O Cards Returned
Returned
EF...e .....--r
ands Not
O Re-Open Account
O Remove Reissue Block
O Add Soc. Sec. #:
O Add Telephone #
O Home
CI Business
O Name Change
Front
To:
.O Address Change to
City, State, ZIP •
K Add Cardholder
O Order Card
O Delete Cardholder
O Add:Authorized User
ID Order Card
O Do Not Order Card
O Delete Authorized User
O Add Credit Rating
O Delete Credit Rating
O Add Type Code
O Delete Type Code
O Add Automatic Payment Deduction
T/R#
Checking Acct#
0 Minimum payment
[Previous balance
O Delete Automatic Payment Deduction
O Add E-mail Address
O Add Mother's Maiden
Name
O Add Secondary CH SS#
O Add Secondary CH DOB
O Add Secondary CH Daytime Phone
O Add Fax Number
K Add Cell Phone#
O Add Pager Number
O Privacy Option
O Do Not Order Card
; Insurance
O Add Insurance
O Delete Insurance
• gadding insurance, attach a signed copy of the insurance application
Free Text Messages/Miscellaneous Instructions
Financial Institution Name:
Authorized Signa
Print
Name:
233-099a NUDSbe 024
For Marital Property States Only
O Married
E
l
Not Married
O Legally Separated
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
O Order New Card for
Must ;nark below to indicate the type of card ordered
Send Card:
CI Normal Delivery — 7 to 10 days
O Express Delivery— 2 days ($10.00 charge)
O Saturday Delivery (Add $10.00)
K Fastcard — 1 day ($20.00 charge)
0 Saturday Delivery (Add $10.00)
Charge:
O Cardholder
O Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
O Charge Cardholder Replacement Card Fee of
PIN Issuance
O Order PIN Reminder
0 PIN Federal Express — 3 days ($10.00 charge)
Charge:
0 Cardholder
0 Financial Institution
O 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 it
To account #
Convenience Checks
O Send Convenience Checks — # of books
Name
•
Street Address
City, Stare, ZIP
Date:
- Oa,
•
Bank # /SS
Agent #
—
Telephone:
xt.
EFTA01700991
IRE
: AUG-00-2002 03:35PM
TEL NUMBER :
NALE
FILE NUMBER
DATE
TO
DOCUMENT PAGES
START TIME
END TIME
SENT PAGES
STATUS
FILE NU ER
: 635
AUG-09 03:34PM
004
AUG-09 03:34PM
AUG-09 03:35PM
004
OK
: 635
***
SUCCESSFUL TX NOTICE ***
AAP Treelese
a teamees.
PAttanellerttO
Conacremtii.r.
Credit
Card
EfOrtiletiola
Cainert
AND wicerz-rdkark• atigastams
Wexner
Street
CITY
Ownosell Names
Collections
Rime=
Account FEW
Close
••• 001.11a • • VD
Delete Cardholder
Zero Cards to Reissue
Q
List on Exception ni
e
lteatrict on PCFNI.AsseSS
C:l stop batmen
C3 Stop Lase Omega
Stop Stammers.
l=
Stop Cmartirnit I Pest Due Notices
Minimum Payment One This Cycle
5
CI
Fix Payment
Ete-Ace amount
Erase Peat Due Stems
1-30
0 lieSCJI
31-.90
S dame
Q
dtaten
S tee
IL
Q
I=I 9te120
w dome
Q
Erase AR
Remove RP leassnieriene
AJ-
Free
Tett
Mess
ratiesataitheellamodus
Instrusetoest
State
EXP
Moo.
C• an
9
cas Ltrolt Increase
to
.-57n 00 -
CI Limit Decease.
to
In
Chemin Corporate
Account Limit to
5
C
Pavers.
Plasma
Mamma of
I=I Raegna
Late Charge Fee of
Reverse Over Limit fee of
Reverse lestusemon Pee of
S
Rovers.
CUL-rent lvrembership
Fce
CI Waive bdereberibly
Fee Pannanently
C3 Itemise
Etripleeentonc Card Fee
S
Iterara.
Convenience
rye
Reverse NSF Fee
Rename Inamenco
*mince Fee
litemerso Eternised Check Fee
S
' Financial Instination Name:
.42
' Authorised
Sitazutasse
Print
*hipbone
a
Name: .
For brarevarne
Csa Col*
Completed
by
Verification
Date:
(1;--cr-j fit as
Hanle F
Scent
0
Date
Data
2-33.-ason re masa ow
Fax re.Sa requests
to Collections,
6O8-24O-76O1i
others
to Account
Processing,
608-240-7605
EFTA01700992
Al? Trechittg Number:
Metavante Corporation
.Credit Card Services
Account Record, Card, PIN
•
Acct
Name
Business Name
/If 4.5 LL C
Actiount Record Changes
g Close Account
0 Cards Returned
0 Re-Open Account
0 Add Soc. Sec. #:
0 .Add Telephone #
0 Home
0 Business
0 Name Change
From:
To:
0 Address Change to
City, State, ZIP
0 Add Cardholder
0 Order Card
0 Do Not Order Card
0 Delete Cardholder
0 Add Authorized User
0 Order Card
0 Do Not Order Card
0 Delete Authorized User
K Add Credit Rating
O Delete Credit Rating
0 Add Type Code
0 Delete Type Code
0 Add Automatic Payment Deduction
TrItet
Checking Acct#
0 Minimum payment
0 Previous balance
O Delete Automatic Payment Deduction
0 Add E-mail Address
0 Add Mother's Maiden
Name
0 Add Secondary CH 55#
0 Add Secondary CH DOB
K Add Secondary CH Daytime Phone
0 Add Fax Number
0 Add Cell Phone#
0 Add Pager Number
0 Privacy Option
Cards Not Returned
Eil
0 Remove Reissue Block
Insurance
0 Add Insurance
0 Delete Insurance
• !fainting itterunce. attach a signed copy of the insurance application
Free Text Messages/Miscellaneous Instructions
For Marital Property States Only
K Married
Spouse's Name
Street Address
City, State, ZIP
Card Issuance
p Order New Card for
Must mark below to Indicate the type of card ordered
Send Card:
K Normal Delivery — 7 to 10 days
0 Express Delivery —2 days (S10.00 charge)
0 Saturday Delivery (Add S10.00)
0 Fastcard — 1 day ($20.00 charge)
0 Saturday Delivery (Add $10.00)
Charge:
0 Cardholder
0 Financial Institution
Address to Mail Card:
Name
Street Address
City. ST, ZIP
ID Charge Cardholder Replacement Card Fee or S
0 Not Married
0 Legally Sepan
PIN Issuance
K Order PIN Reminder
O PIN Federal Express — 3 days (310.00 charge)
Charge:
0 Cardholder
0 Finincial Institution
O Send PIN to Alternate Address Below
Name
'Street Address
City, State, ZIP
Balance I Payment Transfers
Transfer balance of S
From account it'
To account #
Transfer payment of S
From account #
To account #
Convenience Checks
0 Send Convenience Checks — # of books
Name
Street Address
City, State, ZIP
s 3
Financial Institution Name:
Authorized Signature:
Colonial Bank
Bank # 1559
Agent N
Print
Telephone:
Ext.
Name:
21j.eyroi
(I JO
EFTA01700993
Ai? Tracking Number:
Metavante Corporation
.Credit Card Services
Account Record, Card, PIN
count Record Changes
A4 Close Account
0 Cards Returned
Cards Not Returned
0 Re-Open Account
0 Remove Reissue Block
O Add Soc. Sec. tt:
.
0 Add Telephone tit
0 Home
0 Business
0 Name Change
From:
To:
0 Address Change to
City, State, ZIP
0 Add Cardholder
0 Order Card
0 Do Not Order Card
O Delete Cardholder
0 Add Authorized User
0 Order Card
0 Do Not Order Card
O Delete Authorized User
O Add Credit Rating
0 Delete Credit Rating
0 Add Type Code
0 Delete Type Code
0 Add Automatic Payment Deduction
1712.#
Checking Aced/
0 Minimum payment
0 Previous balance
0 Delete Automatic Payment Deduction.
0 Add E-mail Address
0 Add Mother's Maiden
Name
0 Add Secondary CH SS#
0 Add Secondary CH DOB
0 Add Secondary CH Daytime Phone
O Add Fax Number
0 Add Cell Phone#
0 Add Pager Number
0 Privacy Option
Insurance
O Add Insurance
0 Delete Insurance
• !lidding insurance. attach a signed copy of the insurance application
Free Text Messages/Miscellaneous Instructions
For Marital Property States Only
0 Married
O Not Married
Spouse's Name
Street Address
City, Stare, ZIP
0 Legally Separ
Card Issuance
O Order New Card for
Must mark below to indicate the type of card ordered
Send Card:
0 Normal Delivery— 7 to 10 days
O Express Delivery — 2 days (310.00 charge)
0 Saturday Delivery (Add S10.00)
K Fastcard — I day ($20.00 charge)
0 Saturday Delivery (Add S10.00)
Charge:
0 Cardholder
0 Financial Institution
Address to Mail Card:
Name
Street Address
City, ST, ZIP
0.Charge Cardholder Replacement Card Fee of S
PIN Issuance
0 Order PIN Reminder
0 PIN Federal Express — 3 days (510.00 charge)
•
Charge:
0 Cardholder
0 Financial Institution
0 Send PIN to Alternate Address Below
Name
Street Address
City, State, ZIP
Balance / Paythent Transfers
Transfer balance of S
From account if
To account #
Transfer payment of
From. account #
To account
-
Convenience Checks
0 Send Convenience Checks — # of books
Name
•
Street Address
City, State, ZIP
Financial Institution Name.
•
nk
Authorized Signature:
Bank # 1 %co
Print
Telephone:
Maine:
Marrs, sun:au:Is o
•
Date:
Agent N
Ext.
EFTA01700994