Truth in Lending (TILA); Regulation Z

Bur. of Consumer Financial Protection

Pt. 1026, App. G
G–9

APPENDIX G TO PART 1026—OPEN-END
MODEL FORMS AND CLAUSES

lpowell on DSK54DXVN1OFR with $$_JOB

G–1

Balance Computation Methods Model
Clauses (Home-equity Plans) (§§ 1026.6
and 1026.7)
G–1(A) Balance
Computation
Methods
Model Clauses (Plans other than Homeequity Plans) (§§ 1026.6 and 1026.7)
G–2 Liability for Unauthorized Use Model
Clause (Home-equity Plans) (§ 1026.12)
G–2(A) Liability for Unauthorized Use
Model Clause (Plans Other Than Homeequity Plans) (§ 1026.12)
G–3 Long-Form Billing-Error Rights Model
Form (Home-equity Plans) (§§ 1026.6 and
1026.9)
G–3(A) Long-Form
Billing-Error
Rights
Model Form (Plans Other Than Home-equity Plans) (§§ 1026.6 and 1026.9)
G–4 Alternative Billing-Error Rights Model
Form (Home-equity Plans) (§ 1026.9)
G–4(A) Alternative Billing-Error Rights
Model Form (Plans Other Than Home-equity Plans) (§ 1026.9)
G–5 Rescission Model Form (When Opening
an Account) (§ 1026.15)
G–6 Rescission Model Form (For Each
Transaction) (§ 1026.15)
G–7 Rescission Model Form (When Increasing the Credit Limit) (§ 1026.15)
G–8 Rescission Model Form (When Adding a
Security Interest) (§ 1026.15)

Rescission Model Form (When Increasing the Security) (§ 1026.15)
G–10(A) Applications
and
Solicitations
Model Form (Credit Cards) (§ 1026.60(b))
G–10(B) Applications
and
Solicitations
Sample (Credit Cards) (§ 1026.60(b))
G–10(C) Applications
and
Solicitations
Sample (Credit Cards) (§ 1026.60(b))
G–10(D) Applications
and
Solicitations
Model Form (Charge Cards) (§ 1026.60(b))
G–10(E) Applications
and
Solicitations
Sample (Charge Cards) (§ 1026.60(b))
G–11 Applications and Solicitations Made
Available to General Public Model
Clauses (§ 1026.60(e))
G–12 Reserved
G–13(A) Change in Insurance Provider
Model
Form
(Combined
Notice)
(§ 1026.9(f))
G–13(B) Change in Insurance Provider
Model Form (§ 1026.9(f)(2))
G–14A Home-equity Sample
G–14B Home-equity Sample
G–15 Home-equity Model Clauses
G–16(A) Debt Suspension Model Clause
(§ 1026.4(d)(3))
G–16(B)
Debt
Suspension
Sample
(§ 1026.4(d)(3))
G–17(A)
Account-opening
Model
Form
(§ 1026.6(b)(2))
G–17(B)
Account-opening
Sample
(§ 1026.6(b)(2))
G–17(C)
Account-opening
Sample
(§ 1026.6(b)(2))
G–17(D)
Account-opening
Sample
(§ 1026.6(b)(2))
G–18(A) Transactions; Interest Charges; Fees
Sample (§ 1026.7(b))
G–18(B)
Late
Payment
Fee
Sample
(§ 1026.7(b))
G–18(C)(1) Minimum Payment Warning
(When Amortization Occurs and the 36–
Month
Disclosures
Are
Required)
(§ 1026.7(b))
G–18(C)(2) Minimum Payment Warning
(When Amortization Occurs and the 36–
Month Disclosures Are Not Required)
(§ 1026.7(b))
G–18(C)(3) Minimum Payment Warning
(When Negative or No Amortization Occurs) (§ 1026.7(b))
G–18(D) Periodic Statement New Balance,
Due Date, Late Payment and Minimum
Payment
Sample
(Credit
cards)
(§ 1026.7(b))
G–18(E) [Reserved]
G–18(F) Periodic Statement Form
G–18(G) Periodic Statement Form
G–18(H) Deferred Interest Periodic Statement Clause
G–19 Checks Accessing a Credit Card Account Sample (§ 1026.9(b)(3))
G–20 Change-in-Terms Sample (Increase in
Annual Percentage Rate) (§ 1026.9(c)(2))
G–21 Change-in-Terms Sample (Increase in
Fees) (§ 1026.9(c)(2))

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Pt. 1026, App. G

12 CFR Ch. X (1–1–16 Edition)

G–22 Penalty Rate Increase Sample (Payment
60
or
Fewer
Days
Late)
(§ 1026.9(g)(3))
G–23 Penalty Rate Increase Sample (Payment More Than 60 Days Late)
(§ 1026.9(g)(3))
G–24 Deferred
Interest
Offer
Clauses
(§ 1026.16(h))
G–25(A) Consent Form for Over-the-Limit
Transactions (§ 1026.56)
G–25(B) Revocation Notice for Periodic
Statement Regarding Over-the-Limit
Transactions (§ 1026.56)

lpowell on DSK54DXVN1OFR with $$_JOB

G–1—BALANCE COMPUTATION METHODS MODEL
CLAUSES (HOME-EQUITY PLANS)
(a) Adjusted Balance Method
We figure [a portion of] the finance charge
on your account by applying the periodic
rate to the ‘‘adjusted balance’’ of your account. We get the ‘‘adjusted balance’’ by taking the balance you owed at the end of the
previous billing cycle and subtracting [any
unpaid finance charges and] any payments
and credits received during the present billing cycle.
(b) Previous Balance Method
We figure [a portion of] the finance charge
on your account by applying the periodic
rate to the amount you owe at the beginning
of each billing cycle [minus any unpaid finance charges]. We do not subtract any payments or credits received during the billing
cycle. [The amount of payments and credits
to your account this billing cycle was $
llll.]
(c) Average Daily Balance Method (Excluding Current Transactions)
We figure [a portion of] the finance charge
on your account by applying the periodic
rate to the ‘‘average daily balance’’ of your
account (excluding current transactions). To
get the ‘‘average daily balance’’ we take the
beginning balance of your account each day
and subtract any payments or credits [and
any unpaid finance charges]. We do not add
in any new [purchases/advances/loans]. This
gives us the daily balance. Then, we add all
the daily balances for the billing cycle together and divide the total by the number of
days in the billing cycle. This gives us the
‘‘average daily balance.’’
(d) Average Daily Balance Method (Including
Current Transactions)
We figure [a portion of] the finance charge
on your account by applying the periodic
rate to the ‘‘average daily balance’’ of your
account (including current transactions). To
get the ‘‘average daily balance’’ we take the
beginning balance of your account each day,
add any new [purchases/advances/loans], and
subtract any payments or credits, [and unpaid finance charges]. This gives us the daily
balance. Then, we add up all the daily balances for the billing cycle and divide the
total by the number of days in the billing

cycle. This gives us the ‘‘average daily balance.’’
(e) Ending Balance Method
We figure [a portion of] the finance charge
on your account by applying the periodic
rate to the amount you owe at the end of
each billing cycle (including new purchases
and deducting payments and credits made
during the billing cycle).
(f) Daily Balance Method (Including Current
Transactions)
We figure [a portion of] the finance charge
on your account by applying the periodic
rate to the ‘‘daily balance’’ of your account
for each day in the billing cycle. To get the
‘‘daily balance’’ we take the beginning balance of your account each day, add any new
[purchases/advances/fees], and subtract [any
unpaid finance charges and] any payments or
credits. This gives us the daily balance.
G–1(A)—Balance
Computation
Methods
Model Clauses (Plans Other Than HomeEquity Plans)
(a) Adjusted Balance Method
We figure the interest charge on your account by applying the periodic rate to the
‘‘adjusted balance’’ of your account. We get
the ‘‘adjusted balance’’ by taking the balance you owed at the end of the previous
billing cycle and subtracting [any unpaid interest or other finance charges and] any payments and credits received during the
present billing cycle.
(b) Previous Balance Method
We figure the interest charge on your account by applying the periodic rate to the
amount you owe at the beginning of each
billing cycle. We do not subtract any payments or credits received during the billing
cycle.
(c) Average Daily Balance Method (Excluding Current Transactions)
We figure the interest charge on your account by applying the periodic rate to the
‘‘average daily balance’’ of your account. To
get the ‘‘average daily balance’’ we take the
beginning balance of your account each day
and subtract [any unpaid interest or other finance charges and] any payments or credits.
We do not add in any new [purchases/advances/fees]. This gives us the daily balance.
Then, we add all the daily balances for the
billing cycle together and divide the total by
the number of days in the billing cycle. This
gives us the ‘‘average daily balance.’’
(d) Average Daily Balance Method (Including
Current Transactions)
We figure the interest charge on your account by applying the periodic rate to the
‘‘average daily balance’’ of your account. To
get the ‘‘average daily balance’’ we take the
beginning balance of your account each day,
add any new [purchases/advances/fees], and
subtract [any unpaid interest or other finance charges and] any payments or credits.
This gives us the daily balance. Then, we add
up all the daily balances for the billing cycle

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Bur. of Consumer Financial Protection

Pt. 1026, App. G

and divide the total by the number of days in
the billing cycle. This gives us the ‘‘average
daily balance.’’
(e) Ending Balance Method
We figure the interest charge on your account by applying the periodic rate to the
amount you owe at the end of each billing
cycle (including new [purchases/advances/
fees] and deducting payments and credits
made during the billing cycle).
(f) Daily Balance Method (Including Current
Transactions)
We figure the interest charge on your account by applying the periodic rate to the
‘‘daily balance’’ of your account for each day
in the billing cycle. To get the ‘‘daily balance’’ we take the beginning balance of your
account each day, add any new [purchases/
advances/fees], and subtract [any unpaid interest or other finance charges and] any payments or credits. This gives us the daily balance.
G–2—Liability for Unauthorized Use Model
Clause (Home-Equity Plans)
You may be liable for the unauthorized use
of your credit card [or other term that describes the credit card]. You will not be liable for unauthorized use that occurs after
you notify [name of card issuer or its designee] at [address], orally or in writing, of
the loss, theft, or possible unauthorized use.
[You may also contact us on the Web: [Creditor Web or email address]] In any case, your
liability will not exceed [insert $50 or any
lesser amount under agreement with the
cardholder].
G–2(A)—Liability for Unauthorized Use
Model Clause (Plans Other Than Home-Equity Plans)
If you notice the loss or theft of your credit card or a possible unauthorized use of your
card, you should write to us immediately at:
[address] [address listed on your bill],
or call us at [telephone number].
[You may also contact us on the Web:
[Creditor Web or email address]]
You will not be liable for any unauthorized
use that occurs after you notify us. You
may, however, be liable for unauthorized use
that occurs before your notice to us. In any
case, your liability will not exceed [insert $50
or any lesser amount under agreement with
the cardholder].
G–3—LONG-FORM BILLING-ERROR RIGHTS
MODEL FORM (HOME-EQUITY PLANS)

lpowell on DSK54DXVN1OFR with $$_JOB

YOUR BILLING RIGHTS
KEEP THIS NOTICE FOR FUTURE USE
This notice contains important information about your rights and our responsibilities under the Fair Credit Billing Act.

Notify Us in Case of Errors or Questions
About Your Bill
If you think your bill is wrong, or if you
need more information about a transaction
on your bill, write us [on a separate sheet] at
[address] [the address listed on your bill].
Write to us as soon as possible. We must hear
from you no later than 60 days after we sent
you the first bill on which the error or problem appeared. [You may also contact us on
the Web: [Creditor Web or email address]]
You can telephone us, but doing so will not
preserve your rights.
In your letter, give us the following information:
• Your name and account number.
• The dollar amount of the suspected error.
• Describe the error and explain, if you
can, why you believe there is an error. If you
need more information, describe the item
you are not sure about.
If you have authorized us to pay your credit card bill automatically from your savings
or checking account, you can stop the payment on any amount you think is wrong. To
stop the payment your letter must reach us
three business days before the automatic
payment is scheduled to occur.
Your Rights and Our Responsibilities After
We Receive Your Written Notice
We must acknowledge your letter within 30
days, unless we have corrected the error by
then. Within 90 days, we must either correct
the error or explain why we believe the bill
was correct.
After we receive your letter, we cannot try
to collect any amount you question, or report you as delinquent. We can continue to
bill you for the amount you question, including finance charges, and we can apply any
unpaid amount against your credit limit.
You do not have to pay any questioned
amount while we are investigating, but you
are still obligated to pay the parts of your
bill that are not in question.
If we find that we made a mistake on your
bill, you will not have to pay any finance
charges related to any questioned amount. If
we didn’t make a mistake, you may have to
pay finance charges, and you will have to
make up any missed payments on the questioned amount. In either case, we will send
you a statement of the amount you owe and
the date that it is due.
If you fail to pay the amount that we think
you owe, we may report you as delinquent.
However, if our explanation does not satisfy
you and you write to us within ten days telling us that you still refuse to pay, we must
tell anyone we report you to that you have
a question about your bill. And, we must tell
you the name of anyone we reported you to.
We must tell anyone we report you to that
the matter has been settled between us when
it finally is.

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Pt. 1026, App. G

12 CFR Ch. X (1–1–16 Edition)

If we don’t follow these rules, we can’t collect the first $50 of the questioned amount,
even if your bill was correct.
Special Rule for Credit Card Purchases
If you have a problem with the quality of
property or services that you purchased with
a credit card, and you have tried in good
faith to correct the problem with the merchant, you may have the right not to pay the
remaining amount due on the property or
services.
There are two limitations on this right:
(a) You must have made the purchase in
your home state or, if not within your home
state within 100 miles of your current mailing address; and
(b) The purchase price must have been
more than $50.
These limitations do not apply if we own
or operate the merchant, or if we mailed you
the advertisement for the property or services.
G–3(A)—Long-Form Billing-Error Rights
Model Form (Plans Other Than Home-Equity
Plans)
Your Billing Rights: Keep This Document For
Future Use
This notice tells you about your rights and
our responsibilities under the Fair Credit
Billing Act.

lpowell on DSK54DXVN1OFR with $$_JOB

What To Do If You Find A Mistake On Your
Statement
If you think there is an error on your
statement, write to us at:
[Creditor Name]
[Creditor Address]
[You may also contact us on the Web:
[Creditor Web or email address]]
In your letter, give us the following information:
• Account information: Your name and account number.
• Dollar amount: The dollar amount of the
suspected error.
• Description of problem: If you think there
is an error on your bill, describe what you
believe is wrong and why you believe it is a
mistake.
You must contact us:
• Within 60 days after the error appeared
on your statement.
• At least 3 business days before an automated payment is scheduled, if you want to
stop payment on the amount you think is
wrong.
You must notify us of any potential errors
in writing [or electronically]. You may call
us, but if you do we are not required to investigate any potential errors and you may
have to pay the amount in question.

What Will Happen After We Receive Your Letter
When we receive your letter, we must do
two things:
1. Within 30 days of receiving your letter,
we must tell you that we received your letter. We will also tell you if we have already
corrected the error.
2. Within 90 days of receiving your letter,
we must either correct the error or explain
to you why we believe the bill is correct.
While we investigate whether or not there
has been an error:
• We cannot try to collect the amount in
question, or report you as delinquent on that
amount.
• The charge in question may remain on
your statement, and we may continue to
charge you interest on that amount.
• While you do not have to pay the amount
in question, you are responsible for the remainder of your balance.
• We can apply any unpaid amount against
your credit limit.
After we finish our investigation, one of
two things will happen:
• If we made a mistake: You will not have to
pay the amount in question or any interest
or other fees related to that amount.
• If we do not believe there was a mistake:
You will have to pay the amount in question,
along with applicable interest and fees. We
will send you a statement of the amount you
owe and the date payment is due. We may
then report you as delinquent if you do not
pay the amount we think you owe.
If you receive our explanation but still believe your bill is wrong, you must write to us
within 10 days telling us that you still refuse
to pay. If you do so, we cannot report you as
delinquent without also reporting that you
are questioning your bill. We must tell you
the name of anyone to whom we reported
you as delinquent, and we must let those organizations know when the matter has been
settled between us.
If we do not follow all of the rules above,
you do not have to pay the first $50 of the
amount you question even if your bill is correct.
Your Rights If You Are Dissatisfied With Your
Credit Card Purchases
If you are dissatisfied with the goods or
services that you have purchased with your
credit card, and you have tried in good faith
to correct the problem with the merchant,
you may have the right not to pay the remaining amount due on the purchase.
To use this right, all of the following must
be true:
1. The purchase must have been made in
your home state or within 100 miles of your
current mailing address, and the purchase
price must have been more than $50. (NOTE:
Neither of these are necessary if your purchase was based on an advertisement we

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Bur. of Consumer Financial Protection

Pt. 1026, App. G

mailed to you, or if we own the company
that sold you the goods or services.)
2. You must have used your credit card for
the purchase. Purchases made with cash advances from an ATM or with a check that accesses your credit card account do not qualify.
3. You must not yet have fully paid for the
purchase.
If all of the criteria above are met and you
are still dissatisfied with the purchase, contact us in writing [or electronically] at:
[Creditor Name]
[Creditor Address]
[[Creditor Web or email address]]
While we investigate, the same rules apply
to the disputed amount as discussed above.
After we finish our investigation, we will tell
you our decision. At that point, if we think
you owe an amount and you do not pay, we
may report you as delinquent.
G–4—ALTERNATIVE BILLING-ERROR RIGHTS
MODEL FORM (HOME-EQUITY PLANS)
BILLING RIGHTS SUMMARY
In Case of Errors or Questions About Your Bill
If you think your bill is wrong, or if you
need more information about a transaction
on your bill, write us [on a separate sheet] at
[address] [the address shown on your bill] as
soon as possible. [You may also contact us
on the Web: [Creditor Web or email address].]
We must hear from you no later than 60 days
after we sent you the first bill on which the
error or problem appeared. You can telephone us, but doing so will not preserve your
rights.
In your letter, give us the following information:
• Your name and account number.
• The dollar amount of the suspected error.
• Describe the error and explain, if you
can, why you believe there is an error. If you
need more information, describe the item
you are unsure about.
You do not have to pay any amount in
question while we are investigating, but you
are still obligated to pay the parts of your
bill that are not in question. While we investigate your question, we cannot report you
as delinquent or take any action to collect
the amount you question.

lpowell on DSK54DXVN1OFR with $$_JOB

Special Rule for Credit Card Purchases
If you have a problem with the quality of
goods or services that you purchased with a
credit card, and you have tried in good faith
to correct the problem with the merchant,
you may not have to pay the remaining
amount due on the goods or services. You
have this protection only when the purchase
price was more than $50 and the purchase
was made in your home state or within 100
miles of your mailing address. (If we own or
operate the merchant, or if we mailed you

the advertisement for the property or services, all purchases are covered regardless of
amount or location of purchase.)
G–4(A)—ALTERNATIVE BILLING-ERROR RIGHTS
MODEL FORM (PLANS OTHER THAN HOMEEQUITY PLANS)
What To Do If You Think You Find A Mistake
On Your Statement
If you think there is an error on your
statement, write to us at:
[Creditor Name]
[Creditor Address]
[You may also contact us on the Web:
[Creditor Web or email address]]
In your letter, give us the following information:
• Account information: Your name and account number.
• Dollar amount: The dollar amount of the
suspected error.
• Description of Problem: If you think there
is an error on your bill, describe what you
believe is wrong and why you believe it is a
mistake.
You must contact us within 60 days after
the error appeared on your statement.
You must notify us of any potential errors
in writing [or electronically]. You may call
us, but if you do we are not required to investigate any potential errors and you may
have to pay the amount in question.
While we investigate whether or not there
has been an error, the following are true:
• We cannot try to collect the amount in
question, or report you as delinquent on that
amount.
• The charge in question may remain on
your statement, and we may continue to
charge you interest on that amount. But, if
we determine that we made a mistake, you
will not have to pay the amount in question
or any interest or other fees related to that
amount.
• While you do not have to pay the amount
in question, you are responsible for the remainder of your balance.
• We can apply any unpaid amount against
your credit limit.
Your Rights If You Are Dissatisfied With Your
Credit Card Purchases
If you are dissatisfied with the goods or
services that you have purchased with your
credit card, and you have tried in good faith
to correct the problem with the merchant,
you may have the right not to pay the remaining amount due on the purchase.
To use this right, all of the following must
be true:
1. The purchase must have been made in
your home state or within 100 miles of your
current mailing address, and the purchase
price must have been more than $50. (NOTE:
Neither of these is necessary if your purchase was based on an advertisement we

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Pt. 1026, App. G

12 CFR Ch. X (1–1–16 Edition)
[Creditor Name]
[Creditor Address]
[[Creditor Web address]]
While we investigate, the same rules apply
to the disputed amount as discussed above.
After we finish our investigation, we will tell
you our decision. At that point, if we think
you owe an amount and you do not pay we
may report you as delinquent.

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ER22DE11.003

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mailed to you, or if we own the company
that sold you the goods or services.)
2. You must have used your credit card for
the purchase. Purchases made with cash advances from an ATM or with a check that accesses your credit card account do not qualify.
3. You must not yet have fully paid for the
purchase.
If all of the criteria above are met and you
are still dissatisfied with the purchase, contact us in writing [or electronically] at:

Pt. 1026, App. G

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ER22DE11.011

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Pt. 1026, App. G

Bur. of Consumer Financial Protection

Pt. 1026, App. G

G–11—APPLICATIONS AND SOLICITATIONS MADE
AVAILABLE TO THE GENERAL PUBLIC MODEL
CLAUSES
(a) Disclosure of Required Credit Information
The information about the costs of the
card described in this [application]/[solicitation] is accurate as of (month/year). This information may have changed after that date.
To find out what may have changed, [call us
at (telephone number)][write to us at
(address)].
(b) No Disclosure of Credit Information
There are costs associated with the use of
this card. To obtain information about these
costs, call us at (telephone number) or write
to us at (address).
G–12 [RESERVED]
G–13(A)—CHANGE IN INSURANCE PROVIDER
MODEL FORM (COMBINED NOTICE)

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The credit card account you have with us
is insured. This is to notify you that we plan
to replace your current coverage with insurance coverage from a different insurer.
If we obtain insurance for your account
from a different insurer, you may cancel the
insurance.
[Your premium rate will increase to $ ll
per ll.]
[Your coverage will be affected by the following:
[ ] The elimination of a type of coverage
previously provided to you. [(explanation)]
[See ll of the attached policy for details.]
[ ] A lowering of the age at which your
coverage will terminate or will become more

restrictive. [(explanation)] [See ll of the
attached policy or certificate for details.]
[ ] A decrease in your maximum insurable
loan balance, maximum periodic benefit payment, maximum number of payments, or any
other decrease in the dollar amount of your
coverage or benefits. [(explanation)] [See
ll of the attached policy or certificate for
details.]
[ ] A restriction on the eligibility for benefits for you or others. [(explanation)] [See
ll of the attached policy or certificate for
details.]
[ ] A restriction in the definition of ‘‘disability’’ or other key term of coverage. [(explanation)] [See ll of the attached policy
or certificate for details.]
[ ] The addition of exclusions or limitations that are broader or other than those
under the current coverage. [(explanation)]
[See ll of the attached policy or certificate
for details.]
[ ] An increase in the elimination (waiting) period or a change to nonretroactive
coverage. [(explanation)] [See ll of the attached policy or certificate for details).]
[The name and mailing address of the new
insurer providing the coverage for your account is (name and address).]
G–13(B)—CHANGE IN INSURANCE PROVIDER
MODEL FORM
We have changed the insurer providing the
coverage for your account. The new insurer’s
name and address are (name and address). A
copy of the new policy or certificate is attached.
You may cancel the insurance for your account.

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12 CFR Ch. X (1–1–16 Edition)

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ER22DE11.012

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Pt. 1026, App. G

Pt. 1026, App. G

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ER22DE11.013

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ER22DE11.014

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Pt. 1026, App. G

Pt. 1026, App. G

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ER22DE11.015

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ER22DE11.016

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Pt. 1026, App. G

Pt. 1026, App. G

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ER22DE11.017

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ER22DE11.018

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Pt. 1026, App. G

Pt. 1026, App. G

G–16(A) DEBT SUSPENSION MODEL CLAUSE

G–16(B) DEBT SUSPENSION SAMPLE

Please enroll me in the optional [insert
name of program], and bill my account the
fee of [how cost is determined]. I understand
that enrollment is not required to obtain
credit. I also understand that depending on
the event, the protection may only temporarily suspend my duty to make minimum
payments, not reduce the balance I owe. I
understand that my balance will actually
grow during the suspension period as interest continues to accumulate.
[To Enroll, Sign Here]/[To Enroll, Initial
Here]. Xllllllllll

Please enroll me in the optional [name of
program], and bill my account the fee of $.83
per $100 of my month-end account balance. I
understand that enrollment is not required
to obtain credit. I also understand that depending on the event, the protection may
only temporarily suspend my duty to make
minimum payments, not reduce the balance
I owe. I understand that my balance will actually grow during the suspension period as
interest continues to accumulate.
To
Enroll,
Initial
Here.
Xllllllllll

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ER22DE11.019

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12 CFR Ch. X (1–1–16 Edition)

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ER22DE11.020

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Pt. 1026, App. G

Pt. 1026, App. G

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ER22DE11.021

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ER22DE11.022

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Pt. 1026, App. G

Pt. 1026, App. G

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ER22DE11.023

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Bur. of Consumer Financial Protection

Pt. 1026, App. G

12 CFR Ch. X (1–1–16 Edition)

G–18(B)—LATE PAYMENT FEE SAMPLE

above, you may have to pay a $35 late fee and
your APRs may be increased up to the Penalty APR of 28.99%.

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ER22DE11.024

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Late Payment Warning: If we do not receive
your minimum payment by the date listed

Pt. 1026, App. G

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ER22DE11.025

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Bur. of Consumer Financial Protection

Pt. 1026, App. G

12 CFR Ch. X (1–1–16 Edition)

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ER22DE11.026

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G–18(E) [RESERVED]

Pt. 1026, App. G

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ER22DE11.027

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ER22DE11.028

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Pt. 1026, App. G

Pt. 1026, App. G

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ER22DE11.029

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Bur. of Consumer Financial Protection

Pt. 1026, App. G

12 CFR Ch. X (1–1–16 Edition)

G–18(H)—DEFERRED INTEREST PERIODIC
STATEMENT CLAUSE

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ER22DE11.030

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[You must pay your promotional balance
in full by [date] to avoid paying accrued interest charges.]

Pt. 1026, App. G

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ER22DE11.032

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Pt. 1026, App. G

Bur. of Consumer Financial Protection

Pt. 1026, App. H

G–24—DEFERRED INTEREST OFFER CLAUSES
(a) For Credit Card Accounts Under an OpenEnd (Not Home-Secured) Consumer Credit Plan
[Interest will be charged to your account
from the purchase date if the purchase balance is not paid in full within the/by [deferred interest period/date] or if you make a
late payment.]
(b) For Other Open-End Plans
[Interest will be charged to your account
from the purchase date if the purchase balance is not paid in full within the/by [deferred interest period/date] or if your account is otherwise in default.]

credit limit, we will charge you a fee of up to
$35. We may also increase your APRs. To remove over-the-credit-limit coverage from
your account, call us at 1–800-xxxxxxx or
visit [insert Web site].
[You may also write us at: [insert address].]
[You may also check or initial the box
below and return this form to us at: [insert
address].
l I want to cancel over-the-limit coverage
for my account.
Printed Name:
lllllllllllllll
Date: llllllllllllllllllll
[Account Number]: lllllllllllll

G–25(A)—CONSENT FORM FOR OVER-THECREDIT LIMIT TRANSACTIONS
Your Choice Regarding Over-the-Credit Limit
Coverage
Unless you tell us otherwise, we will decline any transaction that causes you to go
over your credit limit. If you want us to authorize these transactions, you can request
over-the-credit limit coverage.
If you have over-the-credit limit coverage
and you go over your credit limit, we will
charge you a fee of up to $35. We may also increase your APRs to the Penalty APR of
XX.XX%. You will only pay one fee per billing cycle, even if you go over your limit multiple times in the same cycle.
Even if you request over-the-credit limit
coverage, in some cases we may still decline
a transaction that would cause you to go
over your limit, such as if you are past due
or significantly over your credit limit.
If you want over-the-limit coverage and to
allow us to authorize transactions that go
over your credit limit, please:
—Call us at [telephone number];
—Visit [Web site]; or
—Check or initial the box below, and return
the form to us at [address].
llllllllll
l I want over-the-limit coverage. I understand that if I go over my credit limit, my
APRs may be increased and I will be charged
a fee of up to $35. [I have the right to cancel
this coverage at any time.]
[l I do not want over-the-limit coverage. I
understand that transactions that exceed my
credit limit will not be authorized.]
Printed Name:
lllllllllllllll
Date: llllllllllllllllllll
[Account Number]: lllllllllllll

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G–25(B)—REVOCATION NOTICE FOR PERIODIC
STATEMENT REGARDING OVER-THE-CREDIT
LIMIT TRANSACTIONS
You currently have over-the-credit limit
coverage on your account, which means that
we pay transactions that cause you go to
over your credit limit. If you do go over your

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