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

XXX Bank Credit Card Account Statement 


Account Number XXXX XXXX XXXX XXXX 


February 21, 2012 to March 22, 2012 


Summary of Account Activity 

Previous Balance $80.52 

Payments -$50.00 

Other Credits +$0.00 

Purchases +$52.13 

Balance Transfers +$0.00 

Cash Advances +$0.00 

Past Due Amount +$0.00 

Fees Charged +$37.00 

Interest Charged +$0.00 

New Balance $119.65 

Credit limit $2,000.00 

Available credit $1,880.35 

Statement closing date 3/22/2012 

Days in billing cycle 30 

QUESTIONS? 

Call Customer Service 1-XXX-XXX-XXXX 

Lost or Stolen Credit Card 1-XXX-XXX-XXXX 

Payment Information 

New Balance $119.65 

Minimum Payment Due $10.00 

Payment Due Date 4/20/12 

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 of28.99%. 

Minimum Payment Warning: 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, Any town, Anystate XXXXX 

Notice of Changes to Your Interest Rates 

You have triggered the Penalty APR of 28.99%. This change will impact your account as follows: 

Transactions made on or after 4/2/12: As of 5/1 0/12, the Penalty APR will apply to these transactions. We may keep the 

APR at this level indefinitely. 

Transactions made before 4/2/12: Current rates will continue to apply to these transactions. However, if you become more 

than 30 days late on your account, the Penalty APR will apply to those transactions as well. 

Transactions

Reference Number Trans Date Post Date Description of Transaction or Credit Amount 

Payments and Other Credits 

854338203FS8000Z5 2/25 2/25 Pymt Thank You $50.00­

Purchases 

5884186PS0388W6YM 2/22 2/23 Store #1 $2.05 

0544400060ZLV72VL 2/24 2/25 Store #2 $2.11 

55541860705RDYDOX 2/24 2/25 Store #3 $4.63 

554328608008W90MO 2/24 2/25 Store #4 $4.95 

054830709 L YM RPT4L 2/24 2/25 Store #5 $7.35 

564891561545KOSHD 2/25 2/26 Store #6 $4.35 

841517877845AKOJIO 2/25 2/26 Store #7 $2.35 

895848561561894KOH 2/26 2/27 Store #8 $7.68 

1871556189456SAMKL 2/26 2/27 Store #9 $4.76 

2564894185189LKDFID 2/27 2/28 Store #10 $2.87 

55542818705RASDOX 3/1 3/2 Store #11 $3.76 

178105417841045784 3/2 3/6 Store #12 $2.35 

8456152156181 SDSA 3/5 3/12 Store #13 $2.92 

(transactions continued on next page) 

NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION 

Page 1 of2

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

Account Number: xxxxXXXX XXXX XXXX 

New Balance $119.65 

Minimum Payment Due $10.00 

Payment Due Date 4/20/12

AMOUNTENCLOSED: Please indicate address change and additional 

cardholder requests on the reverse side. 

xxx Bank 

P.O. Box XXXX 

Anytown, Anystate XXXXX 

dd dlid lid Ilid IllId d dlllliid 1IIIIId dlllilid lid I

1111 dIlIlId I d Ilid lid III d1IIIIIIIIIIIIdddd 111111111 
XXX Bank Credit Card Account Statement 
 Page 2 of 2 

Account Number XXXX XXXX XXXX XXXX 


February 21, 2012 to March 22, 2012 


Transactions (cont.)

Reference Number Trans Date Post Date Description of Transaction or Credit Amount 

Fees 

9525156489SFD4545Q 2/23 2/23 Late Fee $35.00 

564156156470JSNDS 3/22 3/22 Minimum Charge $2.00 

TOTAL FEES FOR THIS PERIOD $37.00 

Interest Charged 

Interest Charge on Purchases $0.00 

Interest Charge on Cash Advances $0.00 

TOTAL INTEREST FOR THIS PERIOD $0.00 

2012 Totals Year-to-Date 

Total fees charged in 2012 $90.14 

Total interest charged in 2012 $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 

Purchases 14.99% (v) $113.80 $0.00 

Cash Advances 21.99% (v) $0.00 $0.00 

Balance Transfers 0.00% $0.00 $0.00 

(v) =Variable Rate