PTO-2234 Deposit Account Closure Request Form

Chief Financial Officer

Deposit Account Closure Request Form (PTO-2234)
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There is a waiting period of six consecutive weeks with no activity before an account can be
closed to ensure that all outstanding charges have been applied.
If the account is currently inactive and has been for at least six consecutive weeks, the account
will be closed upon receipt of the request.
The remaining balance in the account will be refunded via Electronic Funds Transfer (EFT) to the
bank account provided below.
You will receive a confirmation letter when the account is closed indicating the remaining balance
to be refunded, and the expected timeframe to receive the refund.

Please provide the following information to close your deposit account:
Date of Request:
Deposit Account Number:
Name on Deposit Account Statement:
Name of Bank:
Name of Bank Account Holder:
Bank Routing Number:
Bank Account Number:
Name (of authorized user):
Signature (of authorized user):
Contact Telephone Number:
Submit this completed form to the Deposit Account Branch by fax at (571) 273-6500, or by mail
addressed to:
Mail Stop 16
Director of the U.S. Patent and Trademark Office
PO Box 1450
Alexandria, VA 22313-1450
If you have questions or need assistance, call the Deposit Account Branch at (571) 272-6500.

P.O. Box 1450, Alexandria, Virginia 22313-1450 – WWW.USPTO.GOV

Paperwork Reduction Act
The Deposit Account Closure Request Form (PTO-2234) is approved for use through 02/28/2009 under
OMB control number 0651-0043. This collection of information is required by 35 U.S.C. § 41 or 15 U.S.C.
§ 1113 and 37 CFR 1.25 and 2.208. The information is required in order for the public to close an existing
deposit account at the USPTO. This form is estimated to take 4 minutes to complete, including gathering
information, preparing, and submitting the completed Deposit Account Closure Request Form to the
USPTO. Time will vary depending upon the individual case. Please send any comments on the amount of
time required to complete this form and/or suggestions for reducing this burden to the Chief Information
Officer, USPTO, PO Box 1450, Alexandria, VA 22313-1450. DO NOT SEND COMPLETED FORMS TO
THIS ADDRESS. PLEASE SEND COMPLETED FORMS TO: Mail Stop 16, Director of the USPTO, PO
Box 1450, Alexandria, VA 22313-1450; or fax to the Deposit Account Branch at (571) 273-6500.

Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with
your request for, or maintenance of, a deposit account. Accordingly, pursuant to the requirements of the
Act, please be advised that: (1) the authority for the collection of this information is 35 U.S.C. 2, 37 CFR
1.25, and 37 CFR 2.208; (2) furnishing of the information solicited is voluntary; and (3) the principal
purpose for which the information is used by the U.S. Patent and Trademark Office is to establish a
deposit account, maintain existing accounts, or charge the appropriate fee amount to the appropriate
deposit account. If you do not furnish the requested information, the U.S. Patent and Trademark Office
may not be able to establish a deposit account, properly account for funds submitted to maintain the
account, or debit fees from the correct deposit account.
The information provided by you in this form will be subject to the following routine uses:
1. The information on this form will be treated confidentially to the extent allowed under the Freedom
of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552(a)). Records from this system
of records may be disclosed to the Department of Justice to determine whether disclosure of
these records is required by the Freedom of Information Act.
2. A record from this system of records may be disclosed, as a routine use, in the course of
presenting evidence to a court, magistrate, or administrative tribunal, including disclosures to
opposing counsel in the course of settlement negotiations.
3. A record in this system of records may be disclosed, as a routine use, to a Member of Congress
submitting a request involving an individual when the individual has requested assistance from
the Member with respect to the subject matter of the record.
4. A record in this system of records may be disclosed, as a routine use, to a contractor of the
Agency having need for the information in order to perform the contract. Recipients of information
shall be required to comply with the requirements of the Privacy Act of 1974, as amended,
pursuant to 5 U.S.C. 552a(m).
5. A record from this system of records may be disclosed, as a routine use, to the Administrator,
General Services, or his designee, during an inspection of records conducted by GSA as part of
that agency’s responsibility to recommend improvements in records management practices and
programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shall be made in
accordance with the GSA regulations governing inspection of records for this purpose, and any
other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make
determinations about individuals.