Form PTO-2236 EFT User Profile Form

Create New EFT User Profile

PTO-2236 (02-2006)
Approved for use through 12/31/2011. 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 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.
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. If needed,
the USPTO's ACH company ID number is 1310000101.
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. 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.
Create EFT User Profile Form (* Required Field)

* 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)
* Street Address 1:
Street Address 2:

* City:
* State:

ALABAMA

6

* Zip Code:

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Create New EFT User Profile

UNITED STATES

* Country:

6

* Bank Name:
* Bank Routing Number:
* Re-Enter Bank Routing Number:
* Bank Account Number:
* Re-Enter Bank Account Number:
* Bank Account Type:
* Bank Account Classification:
* Contact Phone Number:

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

* Contact E-mail Address:
* Re-Enter Contact E-mail Address:
After entering this information you will have a UserID and Password, which may be used to perform EFT transactions after
the banking information has been verified. Be sure to keep your UserID and Password in a safe place.
Submit

Cancel

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.

Need Help? | USPTO Home Page | Finance Online Shopping Page | Alerts Page

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Privacy Act EFT User Profile

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.

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