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Bank Name:  _______________________________


Charter:  ________________                                                                              


Please note the following reporting requirements for Independent Credit Card Banks:


Currently receivables attributable (as defined below) is not a separately reported amount included in the regular quarterly call report. In order to comply with the independent credit card assessment that applies to this component, it is necessary for you to provide the following information.



Total off balance sheet receivables attributable (in $ millions) to credit card accounts owned by your institution as of the call date, June 30, 2004.  Where there are no receivables meeting this requirement indicate NONE.







Signed Name:  ________________________________ Phone Number ________________



Printed name: _________________________________



 Prior to the due date of July 31, 2004, please FAX this completed form to: Revenue Accounting   (202) 874-5171



Receivables attributable is the total amount of outstanding balances due on credit card accounts owned by an independent credit card bank (the receivables attributable to those accounts) on the last day of the assessment period, minus receivables retained on the bank’s balance sheet as of that day.


For specific questions concerning assessments, please call our 24-hour, toll free number at 866-874-5150.  Leave a detailed message and a staff member will return your call promptly.