G-18(H) Periodic Statement Form Page 1 of 2

XXX Bank Credit Card Account Statement

Account Number XXXX XXXX XXXX XXXX

February 21, 2007 to March 22, 2007

Summary of Account Activity

Previous Balance 

Payments 

Other Credits 

Purchases 

Balance Transfers 

Cash Advances 

Past Due Amount 

Fees Charged 

Interest Charged 

$80.52 

-$50.00 

+$0.00 

+$52.13 

+$0.00

+$0.00 

+$0.00 

+$37.00 

+$0.00 

New Balance $119.65 

Credit limit 

Available credit 

Statement closing date 

Days in billing cycle 

$2,000.00 

$1,880.35 

3/22/2007 

30 

 

Payment Information

New Balance $119.65 

Minimum Payment Due $10.00 

Payment Due Date 4/20/07 (before 2:00 pm) 

Late Payment Warning: If we do not receive your 

minimum payment by the date listed above, you may have 

to pay a $35 late fee and your APRs may be increased up 

to the Penalty APR of 28.99%. 

Notice about Minimum Payments: If you make only the 

minimum payment each month, it will take you about 13 

months to repay the balance shown on this statement.

Please send billing inquiries and correspondence to: 

PO Box XXXX, Anytown, Anystate XXXXX 

QUESTIONS? 

Call Customer Service 

lost or Stolen Credit Card 

1-XXX-XXX-XXXX 

1-XXX-XXX-XXXX 

Notice of Changes to Your Interest Rates

You have triggered the Penalty APR of 28.99%. Effective 5/10/07, we will apply the penalty rate to 

all balances on this account. We may keep your APRs at this level indefinitely. 

Transactions

Reference Number 

854338203FS8OO0z5 

5884186PS0388w6YM 

0544400060zlV72Vl 

55541860705RDYD0X 

554328608008w90M0 

054830709lYMRPT4l 

564891561545KOSHD 

841517877845AKOJIO 

895848561561894KOH 

1871556189456SAMKl 

2564894185189lKDFID 

55542818705RASD0X 

178105417841045784 

8456152156181SDSA 

Trans Date 

2/25 

2/22 

2/24 

2/24 

2/24 

2/24 

2/25 

2/25 

2/26 

2/26 

2/27 

3/1 

3/2 

3/5 

Post Date Description of Transaction or Credit Amount 

Payments and Other Credits 

2/25 Pymt Thank You $50.00– 

Purchases 

2/23 Store #1 $2.05 

2/25 Store #2 $2.11 

2/25 Store #3 $4.63 

2/25 Store #4 $4.95 

2/25 Store #5 $7.35 

2/26 Store #6 $4.35 

2/26 Store #7 $2.35 

2/27 Store #8 $7.68 

2/27 Store #9 $4.76 

2/28 Store #10 $2.87 

3/2 Store #11 $3.76 

3/6 Store #12 $2.35 

3/12 Store #13 $2.92 

(transactions continued on next page) 

NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION 

Page 1 of 2 

Please detach this portion and return with your payment to insure proper credit. Retain upper portion for your records. 

Account Number: XXXX XXXX XXXX XXXX 

New Balance $119.65 

Minimum Payment Due $10.00

Payment Due Date 4/20/07 (before 2:00 pm) 

AMOUNT ENCLOSED: $ Please indicate address change and additional 

cardholder requests on the reverse side. 

XXX Bank 

P.O. Box XXXX 

Anytown, Anystate XXXXX

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XXX Bank Credit Card Account Statement Page 2 of 2 

Account Number XXXX XXXX XXXX XXXX 

February 21, 2007 to March 22, 2007 

Transactions (cont.)

Reference Number Trans Date Post Date Description of Transaction or Credit 

Fees 

9525156489SFD4545Q 2/23 2/23 Late Fee 

56415615647OJSNDS 3/22 3/22 Minimum Charge *Fixed Fee* 

TOTAL FEES FOR THIS PERIOD 

Interest Charged 

Interest Charge on Purchases 

Interest Charge on Cash Advances 

TOTAL INTEREST FOR THIS PERIOD 

Amount

$35.00 

$2.00 

$37.00 

$0.00 

$0.00 

$0.00 

2007 Totals Year-to-Date 

Total fees charged in 2007 $90.14

Total interest charged in 2007 $18.27

Interest Charge Calculation 

Your Annual Percentage Rate (APR) is the annual interest rate on your account. 

Type of Balance Annual Percentage Rate (APR) 

Balance Subject to 

Interest Rate Interest Charge 

$0.00 

$0.00 

$0.00 

Purchases 14.99% (v) $113.80 

Cash Advances 21.99% (v) $0.00 

Balance Transfers 

(v) = Variable Rate 

0.00% $0.00 

Fee-Inclusive APR

The Fee-Inclusive APRs in this table are the APRs that you paid this period when transaction or fixed fees are taken into 

account as well as interest.

Type of Balance Interest Charges 

Transaction or 

Fixed Fees Fee-Inclusive APR 

Purchases $0.00 $2.00 21.09% 

Cash Advances $0.00 $0.00 0.00% 

Balance Transfers $0.00 $0.00 0.00%