Please enter all of the information, print this form from your browser and mail with payment to the address below.
First		Last
Firm
Address 1
Address 2
City
State		Zip
Taxpayer ID #
Phone:	Area Code:   Number:

Publication	Cost
	$
	$
	$
	$
	$
	$
Total	$

Please send order form and check payable to the Comptroller of the Currency to:

Comptroller of the Currency ATTN: Accounts Receivable 250 E Street, S.W., Mail Stop 4-8 Washington, D.C. 20219

Your Check Is Authorization for an Electronic Funds Transfer: If you send a check as payment, you are authorizing the OCC to convert your check into an electronic funds transfer. In other words, your check will be copied and the account information from the check will be used to transfer funds in the amount of the check from your bank account. If the electronic funds transfer cannot be processed for technical reasons, the OCC will process the copy of your check.

Expect ordered publications to be delivered in four to six weeks. For advice and information about availability, or an urgent need for a publication, please call:

Publications (202) 874-4960 Public Information Room (202) 874-5043

Taxpayer ID Number may be used for the collection and reporting of any delinquent amount arising from doing business with the Federal government per 31 USC 7701.