Afena Balance Transfer Request Form

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					   Afena Balance Transfer Request Form
 YES, I want to transfer the amount shown below on the credit card account with a balance transfer to my Afena VISA credit card
 account number ___________________________________________________________. I understand transfers are subject to my available
 credit. If there is not enough credit available to complete my request, a partial payment may be issued. I will receive a confirmation
 letter for the approved transfer and the exact dollar amount paid to the lender.

(Please Print) List the most important transfer first. Attach additional requests on a separate sheet of paper.



 Card Issuer                                                                                              Complete Account Number




 Payment Address                                          City                 State   Zip                Exact Dollar Amount to be Paid

 By signing below, I certify that I have read and agree to all the terms, authorizations, and disclosures included with this offer.



 Signature                                                                                               Date                                     Daytime Phone
*APR = Annual Percentage Rate. Offer good for a limited time. Subject to all terms and conditions in your cardholder agreement. A minimum of $500 per balance transfer is required to receive the special rate.
 Rate subject to credit approval - 7.9% APR for Visa Gold, 10.9% for Visa Classic. Continue to make the minimum payment on bills you receive during the transfer period in order to avoid past-due notices and
 charges. Transferring balances will not automatically close your accounts. Balance transfers will post as a purchase. Payments and credits are applied to promotional balance first. If payment is received late
 once during the life of the transferred balance, the APR will revert back to your original VISA rate. Promotional rate is for 6 months. After promotional period APR’s of 10.9% for Visa Gold and 13.9% for Visa
 Classic will apply. Offer expires February 20, 2010.