Fillable Printable Instructions for Completing the Credit Card Payment Form

Instructions for Completing the Credit Card Payment Form

United States Patent and Trademark Office

Instructions for Completing the Credit Card Payment Form

Credit Card Information

 Enter all credit card information including the payment amount to be charged to your credit card and

remember to sign the form. The United States Patent and Trademark Office (USPTO) cannot process credit

card payments without an authorized signature. An s-signature on credit card payment forms is not allowed

under 37 CFR 1.4(e).

 The USPTO does not accept a general authorization to charge any payment deficiency or any additional fees

to a credit card.

 The USPTO does not accept debit cards or check cards that require use of a personal identification number

as a method of payment.

Credit Card Billing Address

 Address information is required for credit card pay ment as a means of verification. Failure to co mplete

the address information, including zip/postal code, may result in the payment not being accepted by

your credit card institution.

Request and Payment Information

 Provide a description of your request based on the payment amount. For example, indicate the item as

“basic filing fee” (patent) or “first maintenance fee” (patent maintenance fee) or “application for

registration” (trademark) or “certified copy of a patent” (other fee).

 Indicate the nature of your request by the type of fee you wish to pay: Patent Fee, Patent Maintenance Fee,

Trademark Fee or Other Fee. Complete information for each type of fee as applicable to identify the nature

of your request. Indicate only one type of fee per form.

 If you are requesting and paying a fee based on a previously filed patent or trademark application, indicate

the application/serial number, patent number or registration number that is associated with your request.

“Other Fee” is used to request copies of patent and trademark documents, certified copies, assignments, and

other information products.

 IDON numbers are assigned by the USPTO for customers ordering patent and trademark information and

products specified as “Other Fee” on the order form. If you have been assigned an IDON number from a

previous customer order, include it with your request.

 For more information on USPTO fees an d amounts, refer to the current fee schedule at www.uspto.gov. To

request a copy by mail, call the USPTO Contact Center at (800) 786-9199 or (571) 272-1000. Information

on mailing addresses is also available at www.uspto.gov.

Protect Your Credit Card Information

 The USPTO strongly recommends using this form for credit card payments submitted by mail, facsi mile, or

by hand-delivery. To protect your credit card information use only this form and do not include credit card

information on any other form or document.

 To protect your credit card information, do not submit this form electronica lly through “EFS-Web” or

any other USPTO Web site. Credit card information for electronic credit card payments should be entered

exclusively on the USPTO Web site providing electronic payment capability.

United States Patent and Trademark Office

Instructions for Completing the Credit Card Payment Form

Paperwork Reduction Act Statement

This Credit Card Payment Form (PTO-2038) is approved for use through 01/31/2018 under OMB Control Number 0651-

0043. This co llection of information is required by 15 U.S.C. § 1113 or 35 U.S.C. § 41 and 37 CFR 1.16-1.28, 1.492, or

2.6-2.7. The infor mation must b e provided by a member of the public if he or she chooses to pay a USPTO fee by credit

card. This information is also used by the USPTO to charge the appropriate fee amount to the appropriate credit card

account. This collection is estimated to take two minutes to complete, including gathering and preparing information and

submitting the Credit Card Payment Form (PTO-2038) to the USPTO. Time will vary depending upon th e individual case.

Please send any comments on the amount of time required to complete this form and/or suggestions for reducing the time

burden to the Chief Inf ormation Officer, USPTO, PO Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR

COMPLETED FORMS TO THIS ADDRESS. PLEASE REFER TO THE USPTO WEB SITE FOR THE CORRECT

MAILIN G A D DRESS.

Privacy Act Advisory Statement

The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with the request for

information so licited on the Credit Card Payment Form (PTO-2038). Accordingly, pursua nt to the requirements of the Act,

please be advised that: (1) the authority for the collection of this information is 15 U.S.C. § 1113 or 35 U.S.C. § 41 and

37 CFR 1.16-1.28, 1.492, or 2.6-2.7; (2) furnishing of the information solicited is voluntary; and (3) the principal purpose

for which the information is used by the USPTO is to charge the appropriate fee amount to the appropriate credit card

account. If you do not furnish the requested information, the USPTO may not be able to charge the fee to the credit card or

the credit card institution may refuse to accept the charge, either of which will result in the fee being treated as not having

been paid.

The information provided by you in this form will b e subject to the follo wing rou tine uses:

(1) The information on this form will be treated confidentially to the ex tent allowed under the Freedom

of Informati on Act (5 U.S .C. § 55 2 ) a nd 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

eviden ce to a court, magistrate or administrative tribunal, including disclosures to oppo sing 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 wh en the individual has requested assistance from the

Member with respect to the subj ect 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 197 4, as amended, pursuan t to

5 U.S.C . § 55 2 a (m).

(5) A record from this system of records may be disclosed, as a routine use, to the Administrator, General

Services Administration (GSA), or his designee, during an inspection of records conducted by GSA

as part of that agency’s responsibility to recommend improv ements 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.

PTO-2038 (02-2015)

Approved for use through 01/31/2018. OMB 0651-0043

United States Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE

Under the Paperwork Reduction Act of 1995, no person s are required to respond to a collection of information unless it

displays a valid OMB control number.

Credit Card Payment Form

(Do not submit this form electronically via EFS-Web)

Please Read Instructions before Completing this Form

Credit Card Information

Credit Card Type:  Visa  MasterCard  American Express  Discover

Credit Card Account #:

Credit Card Expiration Date (mm/yyyy):

Name as it Appears on Credit Card:

Payment Amount (US Dollars): $

Cardholder Si gnature: Date (mm/dd/yyyy):

The USPTO does not accept an s-signature (37 CFR 1.4(e)) on credit card payment forms.

Refund Policy: The USPTO may refund a fee paid by mistake or in excess of that required. A change of purpose aft er the payment of a fee

will not entitle a party to a refund of such fee. The USPTO will not refund amounts of $25.00 or less unless a refund is specifically requested

and will not notify the payor of such amounts (37 CFR 1.26). Refund of a fee paid b y credit card will be issued as a credit to the credit card

account to which the fee was charged.

Maximum Daily Limit: There is a $24,999.99 daily limit per credit card account effective June 1, 2015. There is no daily limit for debit cards.

Credit Card Billing Address

Street Address 1:

Street Address 2:

City:

State/Province: Zip/Postal Code:

Country:

Daytime Phone #: Fax #:

Request and Payment Information

Description of Request and Payment Information:

 Patent Fee  Patent Maintenance Fee  Trademark Fee  Other Fee

Application No.

IDON Customer No.

Patent No.

Registration No.

Attorney Docket No.

Identify or Describe Mark

If the cardholder includes a credit card number on any form or document other than the Credit Card Paym ent Form o r

submits this form electronically via EFS-Web, the United States Patent and Trademark Office will not be liable in the

event that the credit card number becomes public knowledge.