PTO-2236 EFT User Profile Form

Create New EFT User Profile

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PTO-2236 (02-2006)
Approved for use through 02/28/2009. OMB 0651-0043
U. S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to
a collection of information unless it displays a valid OMB control number

EFT User Profile
Please read the Electronic Funds Transfer (EFT) disclosure below before establishing an EFT user profile.
EFT Disclosure:
z You must have a U.S. bank account to pay by EFT.
z Contact your financial institution to verify that EFT payments from your bank account are allowed.
z Enter your banking information carefully. For help, refer to the EFT Description.
z Failure to include any leading zeroes in your bank routing number or bank account number may result
in the transaction being declined.
z If your EFT payment is declined, your transaction will be cancelled. Any product/service fee you are
trying to pay that is time-sensitive (e.g., Patent maintenance fee, Trademark renewal fee, etc.) will not
be considered timely and may result in the expiration of the Patent or Trademark.
z There is a $50 service charge for processing each payment refused (including an EFT payment that is
declined) or charged back by a financial institution (37 CFR 1.21(m) or 2.6(b)(12)).
z Privacy Act Statement for EFT User Profile Form
Use the U.S. check sample below as a guide to obtain the banking information, which may appear differently on your
check.

You must create a unique user ID and password and complete all the required fields in bold text below. Obtain
detailed information on any field by clicking on the text. When finished, press the "Submit" button at the bottom of the
page to establish your new EFT user profile.

User ID(4 to 8 characters):
Password(6 to 8 characters):
Re-Enter Password:
Customer Name: (please enter your name
exactly as it appears on your bank account)

Create New EFT User Profile

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Street Address 1:
Street Address 2:
City:
State:

CLICK TO SELECT

Zip Code:
Country:

USA

Bank Name:
Bank Routing Number:
Re-Enter Bank Routing Number:
Bank Account Number:
Re-Enter Bank Account Number:
Bank Account Type:

j Checking n
k
l
m
n
j Savings
k
l
m

Bank Account Classification:

j Consumer (Personal) n
k
l
m
n
j Corporate (Business)
k
l
m

Contact Phone Number:
Contact Email Address:
Re-Enter Contact Email Address:

Account Verification: After establishing a new EFT user profile, we must verify your banking information before you
can pay by EFT. You will be notified by e-mail within 7-8 business days of whether your banking information could or
could not be verified.
Submit

This collection of information is required by 35 U.S.C. § 41 or 15 U.S.C. § 1113 and 37 CFR 1.23, 1.25, 2.207, and 2.208. The information is required in
order for the public to establish a user profile at the USPTO for making payments by electronic funds transfer (EFT). This form is estimated to take 2
minutes to complete, including gathering information, preparing, and submitting the completed EFT User Profile 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 FEES OR COMPLETED FORMS TO THIS
ADDRESS.

Privacy Act EFT User Profile

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Privacy Act Statement for EFT User Profiles
AUTHORITY: 35 U.S.C. § 2 and 37 CFR 1.23, 1.25, 2.207, and 2.208
PRINCIPAL PURPOSES: The USPTO collects customer financial information for fee processing. The USPTO charges fees for
processing and other services related to patents, trademarks, and information products. This system of records allows customers
to establish and maintain a user profile in order to make fee payments from their bank accounts by electronic funds transfer
(EFT). The information you provide may be used in order to communicate with you in case there are any problems with the EFT
information or the EFT fee sale. After a sale is completed, the information is used to verify that a customer has paid the
appropriate fees for their goods or services.
DISCLOSURE: Voluntary; however, if you do not furnish the requested information, the USPTO may not be able to establish an
EFT user profile for you and you will not be able to submit payments or replenish deposit accounts online by using EFT.
ROUTINE USES:
1. In the event that a system of records maintained by the Department to carry out its functions indicates a violation or potential
violation of law or contract, whether civil, criminal or regulatory in nature, and whether arising by general statute or particular
program statute or contract, or rule, regulation, or order issued pursuant thereto, or the necessity to protect an interest of the
Department, the relevant records in the system of records may be referred, as a routine use, to the appropriate agency, whether
Federal, state, local or foreign, charged with the responsibility of investigating or prosecuting such violation or charged with
enforcing or implementing the statute or contract, or rule, regulation or order issued pursuant thereto, or protecting the interest of
the Department.
2. A record from this system of records may be disclosed, as a routine use, to a Federal, state or local agency maintaining civil,
criminal or other relevant enforcement information or other pertinent information, such as current licenses, if necessary to obtain
information relevant to a Department decision concerning the assignment, hiring or retention of an individual, the issuance of a
security clearance, the letting of a contract, or the issuance of a license, grant or other benefit.
3. A record from this system of records may be disclosed, as a routine use, to a Federal, state, local, or international agency, in
response to its request, in connection with the assignment, hiring or retention of an individual, the issuance of a security
clearance, the reporting of an investigation of an individual, the letting of a contract, or the issuance of a license, grant, or other
benefit by the requesting agency, to the extent that the information is relevant and necessary to the requesting agency's decision
on the matter.
4. 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.
5. 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.
6. A record in this system of records may be disclosed, as a routine use, to the Department of Justice in connection with
determining whether disclosure thereof is required by the Freedom of Information Act (5 U.S.C. 552).
7. A record in this system of records may be disclosed, as a routine use, to a contractor of the Department having need for the
information in the performance of the contract, but not operating a system of records within the meaning of 5 U.S.C. 552a(m).
8. 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.