+-----------------------------------------------------------------------+
| ## Individually Billed Card Account Setup/Application Form            |
+-----------------------------------------------------------------------+

  -------------------------------- --------------------------------------
  PART I - TO BE COMPLETED BY      PLEASE TYPE OR PRINT ALL INFORMATION
  EMPLOYEE                         

  -------------------------------- --------------------------------------

<table style="width:100%;">
<colgroup>
<col style="width: 20%" />
<col style="width: 23%" />
<col style="width: 4%" />
<col style="width: 15%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p>First Name</p>
<p>     </p></td>
<td><p>Last Name</p>
<p>     </p></td>
<td><p>M I</p>
<p><strong> </strong></p></td>
<td>Social Security Number/Tax ID#</td>
<td> </td>
<td> </td>
<td> </td>
<td>-</td>
<td> </td>
<td> </td>
<td>-</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="even">
<td colspan="5">Date of Birth (mm/dd/yyyy)</td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td>/</td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong>/</strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
</tr>
</tbody>
</table>

+---------------+-----+---------+----------+--------+-----+----------+
| Agency Name:  |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Office        |     |         |          |        |     |          |
| Telephone     |     |         |          |        |     |          |
| Number:       |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Email         |     |         |          |        |     |          |
| Address:      |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Address: If a |     |         |          |        |     |          |
| P.O. Box is   |     |         |          |        |     |          |
| your Primary  |     |         |          |        |     |          |
| Mailing       |     |         |          |        |     |          |
| Address, a    |     |         |          |        |     |          |
| physical      |     |         |          |        |     |          |
| address must  |     |         |          |        |     |          |
| also be       |     |         |          |        |     |          |
| provided. You |     |         |          |        |     |          |
| may input     |     |         |          |        |     |          |
| this address  |     |         |          |        |     |          |
| in the        |     |         |          |        |     |          |
| section       |     |         |          |        |     |          |
| below. An     |     |         |          |        |     |          |
| application   |     |         |          |        |     |          |
| providing     |     |         |          |        |     |          |
| only a P.O.   |     |         |          |        |     |          |
| Box will not  |     |         |          |        |     |          |
| be processed. |     |         |          |        |     |          |
| For APO/FPO   |     |         |          |        |     |          |
| addresses     |     |         |          |        |     |          |
| only, a       |     |         |          |        |     |          |
| physical      |     |         |          |        |     |          |
| address is    |     |         |          |        |     |          |
| not required. |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| **Primary     |     |         |          |        |     |          |
| Mailing       |     |         | **A      |        |     |          |
| Address (25   |     |         | lternate |        |     |          |
| maximum       |     |         | Mailing  |        |     |          |
| characters)** |     |         | Address  |        |     |          |
|               |     |         | (for     |        |     |          |
|               |     |         | newly    |        |     |          |
|               |     |         | issued   |        |     |          |
|               |     |         | card     |        |     |          |
|               |     |         | only)**  |        |     |          |
|               |     |         |          |        |     |          |
|               |     |         | **       |        |     |          |
|               |     |         | Physical |        |     |          |
|               |     |         | Address, |        |     |          |
|               |     |         | if       |        |     |          |
|               |     |         | req      |        |     |          |
|               |     |         | uired.** |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Address Line  |     |         | Address  |        |     |          |
| 1:            |     |         | Line 1:  |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Address Line  |     |         | Address  |        |     |          |
| 2:            |     |         | Line 2:  |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Address Line  |     |         | Address  |        |     |          |
| 3:            |     |         | Line 3:  |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| City or       |     | State:  | City or  |        |     | State:   |
| APO/FPO:      |     |         | APO/FPO: |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Zip:          | Co  |         | Zip:     |        | Co  |          |
|               | unt |         |          |        | unt |          |
|               | ry: |         |          |        | ry: |          |
|               |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| **Signature   |     |         |          |        |     |          |
| and           |     |         |          |        |     |          |
| Agreement:**  |     |         |          |        |     |          |
| After reading |     |         |          |        |     |          |
| the attached  |     |         |          |        |     |          |
| Agreement     |     |         |          |        |     |          |
| between       |     |         |          |        |     |          |
| Government    |     |         |          |        |     |          |
| Employee and  |     |         |          |        |     |          |
| Bank of       |     |         |          |        |     |          |
| America, N.A. |     |         |          |        |     |          |
| (USA)         |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
| ("Ag          |     |         |          |        |     |          |
| reement"): 1. |     |         |          |        |     |          |
| Initial       |     |         |          |        |     |          |
| either A or B |     |         |          |        |     |          |
| below; 2.     |     |         |          |        |     |          |
| Sign; 3.      |     |         |          |        |     |          |
| Obtain your   |     |         |          |        |     |          |
| supervisor's  |     |         |          |        |     |          |
| approval; and |     |         |          |        |     |          |
| 4. Forward    |     |         |          |        |     |          |
| the completed |     |         |          |        |     |          |
| form to your  |     |         |          |        |     |          |
| A/OPC.        |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
| By signing    |     |         |          |        |     |          |
| below, I      |     |         |          |        |     |          |
| acknowledge   |     |         |          |        |     |          |
| that I have   |     |         |          |        |     |          |
| read,         |     |         |          |        |     |          |
| understand    |     |         |          |        |     |          |
| and agree to  |     |         |          |        |     |          |
| be bound by   |     |         |          |        |     |          |
| the terms and |     |         |          |        |     |          |
| conditions of |     |         |          |        |     |          |
| the           |     |         |          |        |     |          |
| agreement. I  |     |         |          |        |     |          |
| attest to the |     |         |          |        |     |          |
| best of my    |     |         |          |        |     |          |
| knowledge,    |     |         |          |        |     |          |
| that the      |     |         |          |        |     |          |
| information I |     |         |          |        |     |          |
| have provided |     |         |          |        |     |          |
| herein is     |     |         |          |        |     |          |
| true and      |     |         |          |        |     |          |
| correct.      |     |         |          |        |     |          |
| Additionally. |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
| A.  **[    ]{ |     |         |          |        |     |          |
| .underline}** |     |         |          |        |     |          |
|     I         |     |         |          |        |     |          |
|     authorize |     |         |          |        |     |          |
|     Bank of   |     |         |          |        |     |          |
|     America   |     |         |          |        |     |          |
|     to obtain |     |         |          |        |     |          |
|     a credit  |     |         |          |        |     |          |
|     report as |     |         |          |        |     |          |
|     described |     |         |          |        |     |          |
|     in the    |     |         |          |        |     |          |
|     agreement |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
| B.  **[    ]{ |     |         |          |        |     |          |
| .underline}** |     |         |          |        |     |          |
|     I do not  |     |         |          |        |     |          |
|     authorize |     |         |          |        |     |          |
|     Bank of   |     |         |          |        |     |          |
|     America   |     |         |          |        |     |          |
|     to obtain |     |         |          |        |     |          |
|     a credit  |     |         |          |        |     |          |
|     report    |     |         |          |        |     |          |
|     and       |     |         |          |        |     |          |
|     therefore |     |         |          |        |     |          |
|     I will    |     |         |          |        |     |          |
|     not be    |     |         |          |        |     |          |
|     eligible  |     |         |          |        |     |          |
|     for a     |     |         |          |        |     |          |
|     standard  |     |         |          |        |     |          |
|     account.  |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| This          |     |         |          |        |     |          |
| application   |     |         |          |        |     |          |
| is for a      |     |         |          |        |     |          |
| Government    |     |         |          |        |     |          |
| Travel Card   |     |         |          |        |     |          |
| Account,      |     |         |          |        |     |          |
| which may be  |     |         |          |        |     |          |
| standard or   |     |         |          |        |     |          |
| restricted,   |     |         |          |        |     |          |
| as described  |     |         |          |        |     |          |
| in Paragraph  |     |         |          |        |     |          |
| 6 of the      |     |         |          |        |     |          |
| attached      |     |         |          |        |     |          |
| Agreement. I  |     |         |          |        |     |          |
| expressly     |     |         |          |        |     |          |
| agree to      |     |         |          |        |     |          |
| accept        |     |         |          |        |     |          |
| whichever     |     |         |          |        |     |          |
| type of       |     |         |          |        |     |          |
| account is    |     |         |          |        |     |          |
| established.  |     |         |          |        |     |          |
| Pursuant to   |     |         |          |        |     |          |
| requirements  |     |         |          |        |     |          |
| of law,       |     |         |          |        |     |          |
| including the |     |         |          |        |     |          |
| USA PATRIOT   |     |         |          |        |     |          |
| Act, Bank of  |     |         |          |        |     |          |
| America is    |     |         |          |        |     |          |
| requesting    |     |         |          |        |     |          |
| additional    |     |         |          |        |     |          |
| information   |     |         |          |        |     |          |
| to verify     |     |         |          |        |     |          |
| your          |     |         |          |        |     |          |
| identity.     |     |         |          |        |     |          |
|               |     |         |          |        |     |          |
| **PLEASE      |     |         |          |        |     |          |
| RETAIN COPY   |     |         |          |        |     |          |
| FOR YOUR      |     |         |          |        |     |          |
| RECORDS.**    |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| Employee      |     |         |          | Date:  |     |          |
| Signature     |     |         |          | [      |     |          |
| [             |     |         |          |      ] |     |          |
| ]{.underline} |     |         |          | {.unde |     |          |
|               |     |         |          | rline} |     |          |
+---------------+-----+---------+----------+--------+-----+----------+
| NOTE: See     |     |         |          |        |     |          |
| attached      |     |         |          |        |     |          |
| Agreement     |     |         |          |        |     |          |
| between       |     |         |          |        |     |          |
| Agency        |     |         |          |        |     |          |
| /Organization |     |         |          |        |     |          |
| Employee and  |     |         |          |        |     |          |
| Bank of       |     |         |          |        |     |          |
| America, N.A. |     |         |          |        |     |          |
| (USA) for the |     |         |          |        |     |          |
| terms and     |     |         |          |        |     |          |
| conditions of |     |         |          |        |     |          |
| your Account. |     |         |          |        |     |          |
+---------------+-----+---------+----------+--------+-----+----------+

Instructions for Individually Billed Card Account Setup/Application Form

  ------------- ---------------------------------------------------------
  **Purpose**   Complete this form to establish an individually billed
                travel card account under the GSA Smart Pay Program.

  ------------- ---------------------------------------------------------

+------------+---------------------------------------------------------+
| **Inst     | **Cardholders:** Fill out "To be completed by Employee" |
| ructions** | section. **A/OPCs**: Fill out "To be completed by the   |
|            | Agency/Organization Program Coordinator section. Please |
|            | print or type all information. Mail or fax to:          |
|            |                                                         |
|            | **Bank of America**                                     |
|            |                                                         |
|            | **Attn: GCSU**                                          |
|            |                                                         |
|            | **P. O. Box 1637**                                      |
|            |                                                         |
|            | #  Norfolk, VA 23501-1637                               |
|            |                                                         |
|            | **Fax: (757) 441-4993**                                 |
|            |                                                         |
|            | **Fax: (888) 784-1039 (toll free)**                     |
|            |                                                         |
|            | **Please see page 8 for instructions.**                 |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Field Descriptions**                                                |
|                                                                       |
| **For your assistance, listed below are field descriptions of         |
| elements on the form.**                                               |
+-----------------------------------------------------------------------+
| **First Name, Last Name, MI** -- Employee's first name, last name and |
| middle initial.                                                       |
|                                                                       |
| Pursuant to requirements of law, including the USA PATRIOT Act, Bank  |
| of America is obtaining information and will take necessary actions   |
| to verify your identity.                                              |
+-----------------------------------------------------------------------+
| **Social Security Number/Tax ID** -- Employee's Social Security       |
| Number.                                                               |
+-----------------------------------------------------------------------+
| **Date of Birth -** Complete information as appropriate               |
+-----------------------------------------------------------------------+
| **Agency Name --** Provide name of the Employee's agency name**.**    |
+-----------------------------------------------------------------------+
| **Office Telephone Number** -- Employee's work telephone number,      |
| including Country and Area Codes.                                     |
+-----------------------------------------------------------------------+
| #                                                                     |
| # **E-mail Address** -- List cardholder's email address if available. |
+-----------------------------------------------------------------------+
| **Primary Mailing Address ­**-- This is the address to which the       |
| employee's travel card billing statement should be mailed. If a P.O.  |
| Box is provided, a physical address is required in the designated     |
| section.                                                              |
+-----------------------------------------------------------------------+
| **Alternate Mailing Address or Physical Mailing Address (includes     |
| Street, City, State/Province, Zip/Postal Code, and Country)** --      |
| Complete this section if a P.O. Box is being provided as your Primary |
| Mailing Address. Or, Complete this section if you would like the card |
| mailed to an alternate address that is different than the Primary     |
| Mailing Address to which the regular billing statement will be sent.  |
+-----------------------------------------------------------------------+
| **Signature and Agreement --** Sign application and indicate your     |
| choice by initialing either A. or B.                                  |
|                                                                       |
| -   If an applicant initials B., a restricted card be issued with     |
|     reduced spending limits.                                          |
|                                                                       |
| -   If neither block is initialed, the application will be returned   |
|     to the A/OPC for further instruction.                             |
+-----------------------------------------------------------------------+
| **Date** - Date employee signs this form.                             |
+-----------------------------------------------------------------------+

**IMPORTANT**: BEFORE YOU SIGN THE INDIVIDUALLY BILLED CARD ACCOUNT
SETUP/APPLICATION FORM, OR USE THE GOVERNMENT CARD, READ THIS AGREEMENT
THOROUGHLY. PLEASE RETAIN THIS AGREEMENT FOR YOUR RECORDS.

**1. DEFINITIONS.** In this Agreement, the word \"Agreement\" means this
document as modified by any amendment issued pursuant to Section 13. The
word \"we\" \"Bank of America\" or \"us" refers to Bank of America, N.A.
(USA), and the issuer of the Card. The \"GSA Contract\" refers to the
General Services Administration Contract No. GS-23F-98004. The word
\"Program\" means the card program established pursuant to the GSA
contract. \"Agency/Organization\" means the United States federal
agency, bureau, division, office or other organizational entity
participating in the program that has requested/authorized Bank of
America to open an account for you. The words \"cardholder\", \"you\" or
\"your\" means the Agency/Organization employee whose name appears on
the Card. The word \"Government Card\", \"Card\" or \"Cards\" mean the
card issued to you by us under the Program. \"Account\" means the
account established by us in connection with the Government Card. \"Cash
Advance\" is a cash advance obtained through use of the Account at any
participating affiliated automated teller machine (\"ATM\") or any
financial institution or other establishment authorized to process and
grant you a cash advance.

**2. ACCEPTANCE OF THE AGREEMENT**. BY SIGNING THE INDIVIDUALLY BILLED
CARD ACCOUNT SETUP/APPLICATION FORM, ACTIVATING, SIGNING OR USING THE
CARD AND/OR THE ACCOUNT, YOU AGREE TO BE BOUND BY THE TERMS AND
CONDITIONS OF THIS AGREEMENT. IF YOU DO NOT AGREE TO THE TERMS AND
CONDITIONS OF THIS AGREEMENT, CUT THE CARD IN HALF AND RETURN THE PIECES
TO BANK OF AMERICA.

# 3. OBTAINING CREDIT REPORTS. You authorize Bank of America to obtain reports concerning your credit, from credit bureaus and other credit reporting agencies, consistent  with  your Agency/Organization\'s agreement with union official s  (if applicable).  You may prevent us from obtaining credit bureau information by (i) specifically indicating on your Individually Billed Card Account Setup/Application Form that you do not authorize Bank of America to obtain credit bureau reports concerning your credit or (ii) failing to consent to the terms of this Agreement.

# 4. PROMISE TO PAY LIABILITY. All amounts charged to the Account including purchases, Cash Advances and fees will be called \"Charges.\" You promise to pay for all Charges made by you or anyone you allow to use the Account until paid in full. Official travel and travel-related expenses charged to the Card will be reimbursed by the Agency/Organization under the Agency\'s/Organization\'s expense reimbursement procedures applicable to you. You also agree to report your expenses promptly to the Agency/Organization in accordance with its expense reimbursement procedures. You, as the Cardholder, are responsible for making payment to Bank of America. You are responsible for all Charges made with the Card even if you let someone else use the Card or voluntarily relinquish physical possession of the Card. You must retrieve the Card from that person to avoid further liability.

**5. DISCLOSURE OF ACCOUNT INFORMATION**. In addition to routine uses
under the Privacy Act, you authorize Bank of America to: (1) provide
information about your Account to Bank of America's service providers
administering your Account under the GSA Contract; (2) disclose all
necessary Account information to outside attorneys representing Bank of
America in connection with any legal or administrative proceeding
involving your Account or Bank of America's actions under this
Agreement; (3) provide all necessary Account information to Bank of
America\'s auditors in the course of any audit; (4) disclose all
necessary Account information to outside attorneys, collection agencies
or credit bureaus if we refer all or part of the Account for collection
in accordance with the GSA Contract and your Agency/Organization's Task
Order. You understand that past due Accounts will be reported to your
Agency/Organization. By signing the Individually Billed Card Account
Setup/Application Form, you are providing your written consent to the
disclosure of Account information as provided in this Section 4.

**6. TYPE OF ACCOUNT.** You have been issued either a Restricted or
Standard Account.  A Restricted Account generally has a lower credit
limit and is subject to greater usage restrictions.  The reason(s) a
Restricted Account may have been established include, but are not
limited to, (1) you, as the cardholder did not provide authorization
for Bank of America to acquire a credit report on your financial
history, or (2) the Agency/Organization program coordinator requested a
Restricted Account, or (3) your credit did not meet the minimum
requirements set by the Agency/Organization to qualify for the Standard
Account.  Your Agency/Organization may change your account from a
Standard Account to a Restricted Account or from a Restricted Account to
a Standard Account.

**7. USE OF GOVERNMENT CARD.** You agree to use the Card only for
official travel and official travel related expenses away from your
official station/duty station in accordance with your
Agency/Organization policy. You agree not to use the Card for personal,
family or household purposes. Charging privileges on the Card are
provided by Bank of America pursuant to the GSA Contract and the Task
Order of your Agency/Organization. No other person is permitted to use
the Card issued to you for Charges or for any other reason.

**8. PAYMENT.** We will send statements of all Charges to you. All
payments are due by the due date specified on your statement (\"Due
Date\"). You should notify us immediately of any change in your billing
address by calling the number indicated in Section 14. Payments must be
made in U.S. currency, in electronic form or with a money order payable
in U.S. dollars, or with a draft or a check drawn on a bank in the U.S.
and payable in U.S. dollars. If we decide to accept a payment made in
some other form, payment will not be credited to your Account until your
payment is converted into one of the forms just mentioned. We may accept
late payments, partial payments or checks and money orders marked
\"payment in full\" or with other restrictive endorsements without
losing any rights under this Agreement or under the law.

**9. SUSPENSION AND CANCELLATION**. Suspension or cancellation does not
affect the terms of this Agreement, including without limitation your
obligation to pay the balance of your Account, until your obligation to
Bank of America under this Agreement has been satisfied.

> A. **[Suspension]{.underline}**: Bank of America may suspend your
> Account and prohibit further Charges if (i) payment for any undisputed
> principal amount is not received within 61 calendar days from the
> closing date on the statement in which the unpaid Charge first
> appeared, or within the timeframe specified in the Agency/Organization
> task order, unless otherwise directed by the Agency/Organization
> Program Coordinator, or (ii) the Agency/Organization or GSA requests
> the suspension. Bank of America will reinstate your suspended account
> upon full payment of the amount due unless otherwise directed by the
> Agency/Organization.
>
> B. [**Cancellation by Cardholder**:]{.underline} You may cancel the
> Card at any time by notifying Bank of America, cutting the Card in
> half and returning the parts to Bank of America.
>
> C. **[Cancellation by Bank of America]{.underline}**
>
> (i). [Automatic Cancellation]{.underline}: The Card and the Account
> will automatically be canceled upon (a) termination of your employment
> with the Agency/Organization regardless of the reason; (b) termination
> or expiration of the GSA Contract and/or Agency/Organization task
> order; (c) request of the Agency/Organization or GSA; or (d) request
> of Bank of America with the permission of the Agency/Organization.
> Upon cancellation, you agree to return the Card immediately, cut in
> half, to Bank of America.
>
> (ii). [Cancellation Due to Delinquency]{.underline}: **Bank of America
> may cancel your Account if (a) the Account has been suspended two
> times during a 12 month period for non-payment of undisputed principal
> amounts and is past due again; for purpose of this section
> 7.C.(ii).(a), "past due\" means payment is not received within 45
> calendar days from the closing date on the statement of Account in
> which the Charge first appeared; (b) the Account is 126 calendar days
> past due from the closing date on the statement of Account in which
> the unpaid Charge first appeared, or within the timeframe specified in
> the Agency/Organization task order, unless otherwise directed by the
> Agency/Organization Program Coordinator, or (c) the
> Agency/Organization or GSA requests the cancellation. Bank of America
> may reinstate a canceled Account upon full payment of the amount due
> and any late fee assessed. Account statements may not (at the option
> of Bank of America) be sent after an Account has been canceled.**

# 10. ATM USAGE. If your Agency/Organization is participating in the Bank of America ATM Program for Government Cardholders, you will separately receive a Personal Identification Number (\"PIN\"). You may then obtain Cash Advances at an ATM when authorized in accordance with Agency/Organization procedures. 

**11. NO WAIVER OF BANK OF AMERICA\'S RIGHTS**. All rights and remedies
of Bank of America are cumulative and may be pursued singularly,
successively or together, at the option of Bank of America. Except as
expressly provided below in this Section 9, Bank of America's failure at
any time to exercise any of its rights hereunder or any other rights
shall not constitute a waiver nor otherwise bar the exercise of any of
these options or rights at a later date. Bank of America waives its
right to suspend the Account for a particular Charge if suspension
procedures are not initiated within 180 calendar days of the closing
date on the statement of Account in which the Charge first appeared.
Bank of America waives its right to cancel the Account for a particular
Charge if cancellation procedures are not initiated within 180 calendar
days of the closing date on the statement of Account in which the Charge
first appeared.

**12. TRAVELERS CHECKS**. If your Agency/Organization is participating
in the Bank of America Travelers Check program for Government
Cardholders, you may purchase travelers checks when authorized in
accordance with Agency/Organization procedures and a Travelers Check Fee
of 1.5% of the total amount of the checks purchased will apply. If your
Agency/Organization has negotiated a lower Travelers Checks Fee, the
lower amount will apply.

# 13.CHARGES. You agree to pay the following Charges unless your Agency/Organization has negotiated a lower rate or fee, in which case, you will pay the lower amount.

**[Return Check Fee]{.underline}**. \$20.00 for any payment which is
returned for any reason.

**[Cash Advance Fee]{.underline}**. 1.9% of the amount of each Cash
Advance.

[**Delinquency and Collection Charges**.]{.underline} If Bank of America
refers your Account to any attorney for collection, you will be
responsible for attorney's fees, if any, not to exceed 25% of the
Account balance plus all other costs of collection and court costs
except where prohibited by law.

**[Late Fee]{.underline}**. If your Account has been canceled, \$20.00
for any payment not received within 120 calendar days past the closing
date on the statement of Account in which the Charge first appeared.

**14. FOREIGN TRANSACTIONS/FEES.** If you make a Transaction in currency
other than U.S. dollars, Visa or MasterCard will convert the charge or
credit into a U.S. dollar amount. The conversion rate on the processing
date may differ from the rate on the date of your Transaction.

The exchange rate used by Visa will either be (i) a rate selected by
Visa from a range of rates available in wholesale currency markets for
the applicable central processing date, which rate may differ from the
rate Visa receives, or (ii) the government-mandated rate in effect for
the central processing date. MasterCard will use an exchange rate of
either (i) a wholesale market rate or (ii) a government-mandated rate.
Visa and MasterCard will no longer add a 1% adjustment factor to or show
it as part of the U.S. dollar amount. Instead Visa and MasterCard will
bill the Bank directly. Therefore, for Visa and MasterCard Transactions,
we will charge a 1% amount ("International Transaction Fee"), and show
it as a separate line item, only for those foreign Transactions
converted into U.S. dollars. Each International Transaction Fee will be
shown in the Activity section on your billing statement.

**15.CHANGE IN TERMS**. Bank of America may, with the written consent of
GSA and your Agency/Organization, change the terms of this Agreement
upon 30-day written notice to you. You agree that the new terms provided
in any such notice may apply both to your new transactions and to your
Account balance on the date the change becomes effective. If you do not
agree to a change in terms of this agreement, then prior to the
effective date of the change, you must notify us, cut the card in half
and return the pieces to us.

**16. LOST OR STOLEN CARD/REPLACEMENT**. If your Card is lost or stolen,
or if you think another person may use your Account without your
permission, you must notify Bank of America immediately by calling the
number listed below.

Telephone Numbers:

Within United States 1-800-472-1424\
Collect Calls from out of United States (757) 441-4124

You may confirm your notification by writing to:

Bank of America\
Security Department\
P.O. Box 1350\
Norfolk, VA 23501

If there is any unauthorized use of your Card or Account you agree to
cooperate with Bank of America during its investigation, which will
include your completion of a Cardholder Statement of Disputed Item.
Should you need a replacement card, please call the same telephone
number listed in this Section 14 for lost or stolen Cards.

**17. LIMITATION OF DAMAGES**. In no event shall Bank of America be
liable to you for any consequential, special, indirect or punitive
damages of any nature.

**18. COLLECTION/TELEPHONE MONITORING**. You agree that if you do not
pay your Account, Bank of America or its collection agent may call you
regarding the collection of your Account. You understand that the calls
could be automatically dialed and a recorded message may be played. You
agree such calls will not be \"unsolicited\" calls for purposes of
local, state or federal law. You agree that we may monitor telephone
calls between you and us to ensure the quality of the customer service
we provide.

**19. CHANGES TO NAME, ADDRESS OR EMPLOYMENT**. You understand that Bank
of America will send Account Statements, replacement or renewal Cards,
or other notices at the address shown in its records. You will promptly
notify Bank of America of any change in your name, address or
employment.

**20. NONTRANSFERABLE**. Each Card is nontransferable.

**21. SEVERABILITY**. The invalidity or unenforceability of any
provision of this Agreement will not affect the validity or
enforceability of any other provision of this Agreement.

**22. SUCCESSORS AND ASSIGNS**. You agree that Bank of America may at
any time assign or transfer to another person your Account, your Account
balance, or this Agreement. The persons to whom Bank of America
transfers or assigns your Account, your Account balance, or this
Agreement will have all of Bank of America's rights under this
Agreement. You will not assign or transfer any of your rights or duties
under this Agreement, and this Agreement is binding on your successors,
heirs and legal representatives and upon anyone to whom you assign your
assets or who succeeds to them.

**23. GOVERNING LAW**: This Agreement and your Account are subject to
the GSA Contract and shall be governed by Arizona law and the laws of
the United States. This Agreement is entered into in Arizona and all
credit will be extended by Bank of America from Arizona.

**PRIVACY ACT NOTICE**:

In accordance with the Privacy Act (5 U.S.C. 552a), the following notice
is provided: The information requested on the card application form is
collected pursuant to Executive Order 9397 and chapter 57, title 5,
United States Code, for the purposes of recording travel expenses
incurred by the employee/member and to claim entitlements and allowances
prescribed in applicable federal travel regulations. The purpose of the
collection of this information is to provide Government agencies
necessary information on the GSA travel card contract which provides
travelers with charge cards for official travel and related expenses,
attendant operational and control support, and management information
reports for expense control. Routine uses which may be made of the
collected information and other account information in the system of
records entitled \"Travel Charge Card Program GSA/GOVT-3\" are as
follows: (1) transfers to appropriate Federal, State, local, or foreign
agencies when relevant to civil, criminal, administrative, or regulatory
investigations; (2) pursuant to a request of another Federal agency in
connection with hiring, retention, issuing a security clearance,
reporting an employee investigation, clarifying a job, letter or
contract or issuing a license, grant, or other benefit; (3) to a Member
of Congress or to a Congressional Staff Member in response to an inquiry
of the Congressional Office made at the request of the individual about
whom the record is maintained; (4) to officials of labor organizations
when necessary to their duties of exclusive representation; (5) to a
Federal agency for accumulating reporting data and monitoring the
system; (6) GSA contract travel agents assigned to agencies for billing
of travel expenses; (7) listing, reports, and records to GSA by the
contractor to conduct audits of carrier charges to the Government; and
(8) any other use specified by GSA in the system of records entitled
\"Travel Charge Card Program GSA/GOVT-3,\" as published in the Federal
Register periodically by GSA. The information requested is not
mandatory. Failure to provide the information will nullify the
application, and a charge card will not be issued to the
employee/member.

Convenient and Easy

Make Your Payments by Phone

Bank of America enables you to make payments by phone to your Government
Charge Card account by contacting the Government Card Services Unit.
This service is offered to facilitate the ease of making payments to
your charge card account, however utilizing this service is not a GSA
SmartPay contract requirement. Each Pay by Phone transaction may be
subject to a processing fee. This Agreement applies when utilizing the
Payment by Phone Option.

**Payment by Phone Authorization**

When I use the Payment by Phone option, I hereby authorize Bank of
America, N.A. (USA) (the Bank) to initiate electronic payments from my
designated account at the financial institution I indicate for the
purpose of making any payment on my Government charge card account
(Account). I understand I must authorize the timing and amount of each
payment transaction by providing authentication information requested by
the Bank.

**[I HEREBY AGREE TO THE FOLLOWING TERMS AND CONDITIONS:]{.underline}**

1)  **Processing Fee -** Each Payment by Phone transaction may be
    subject to a fee not to exceed \$10.00. The fee will be added to the
    amount of the payment.

2)  **Effective Date of Payment** -- Payment will occur on the date I
    initiate the request, if requested prior to 6:00 PM ET. If the
    request is initiated after 6 PM ET, the effective date will be the
    following business day.

3)  **Dishonored Request for Payment** -- If a payment is dishonored for
    any reason, including insufficient funds, both the Bank, in
    accordance with my Account agreement, and my financial institution
    may assess a fee. If a payment is dishonored by my financial
    institution for "insufficient funds", the Bank will attempt to
    initiate the electronic payment one more time before deeming the
    payment unpaid. I understand that if a payment is dishonored, my
    Account will be considered due for that payment, and other payment
    arrangements will need to be made.

4)  **In Case of Error** -- If my Account statement indicates an
    incorrect payment or amount or I need more information about a
    payment transaction, I will write or call the Bank at the number or
    address provided on my statement of Account for billing errors. The
    Bank must hear from me no later than 60 days after I have received
    the first statement on which the payment appeared. For more
    information, I can read the back of my Account statement.

5)  **Revocation of a Payment**- After I initiate a Payment by Phone
    transaction, I have until 4:00 PM ET the day of the scheduled
    payment to cancel or revoke that payment.

6)  **Governing Law -** This Authorization shall be governed by and
    interpreted in accordance with the laws of the State of Arizona.

7)  **Authentication Information -** I acknowledge the Bank may require
    additional information from me for authorization and authentication
    of a Payment by Phone transaction. Any information I provide for
    authorization and authentication will be kept confidential by the
    Bank.

8)  **Authorization and Security Procedure --** A Payment by Phone
    transaction will not occur unless I initiate the payment through the
    Bank's automated response unit or speak with the Bank's customer
    service representative**.** I agree that the security procedures
    followed by the Bank to authenticate my consent to a Payment by
    Phone transaction, although not in writing, are reasonable and I
    agree to be bound by them as if I had signed this Authorization in
    writing. I understand that this Authorization is a separate
    agreement from, and does not change, the agreement governing my
    Account.

9)  **Modification of this Authorization** -- The Bank may modify this
    Authorization by changing, adding or deleting any term, condition,
    service or feature ("New Term") at any time. The Bank will provide
    me with notice of the modification to the extent required by law. I
    agree to the "New Term" by conducting a Payment by Phone transaction
    after the Bank provides me notice of the modification.

##### 

**PLEASE RETAIN FOR YOUR RECORDS**

**Please return completed (1) application package (pages 1 and 9 only)
and (2) training certificate to the address below.**

.

**Energy Finance and Accounting Service Center**

**Accounting Operations Division**

**Financial Services Branch**

**Travel Team**

**Room C-277**

**Or Fax to (301) 903-0326**

**In addition to the application, we now require the training
certificate to be completed and sent. It can be obtained on the
following website.**

[[http://fss.gsa.gov/webtraining/trainingdocs/traveltraining/index.cfm]{.underline}](http://fss.gsa.gov/webtraining/trainingdocs/traveltraining/index.cfm)

**If you have any questions, please call (301) 903-2500, option 4,
option 2.**

**U.S. Department of Energy**

**Energy Finance and Accounting Service Center**

**Accounting Operations Division/Financial Services Branch/Travel Team**

**\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\***

**EMPLOYEE ACKNOWLEDGMENT**

**\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\***

***I certify that I will abide by such policies, procedures and other
instructions that may be issued by the Department of Energy and Bank of
America pertaining to the use of the card issued to me for the purposes
of conducting official government travel.***

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Employee Signature**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Ten-Digit Organization Code**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Name of Organization that Corresponds to Org. Code**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Anticipated Travel Date**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Supervisor's Printed Name**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_**

**Supervisor's Signature Date**