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Form Pto-2234 - Deposit Account Closure Request Form - U.s. Patent And Trademark Office

Chief Financial Officer

Deposit Account Closure Request Form (PTO-2234)

• There must be ONE MONTH with no recent activity before a deposit account can be closed to ensure all outstanding

charges have been applied. If this is the case, the account will be closed upon receipt of the request.

• The remaining balance will be refunded via Electronic Funds Transfer (EFT) to the U.S. bank account provided below

(must also provide copy of a voided check). Otherwise, a U.S. Treasury check will be issued to the address on file.

- For non-U.S. bank accounts, a U.S. Treasury check will be issued to the address on file.

- To transfer the remaining balance to another existing deposit account, provide the other deposit account number

below in lieu of banking information.

• You will receive a confirmation letter when the account is closed indicating the remaining balance to be refunded, and

the expected timeframe to receive the refund.

Please provide the following information to close your deposit account:

Date of Request

(mm/dd/yyyy)

Deposit Account Number:

Name on Deposit Account Statement:

Name of Bank:

Name of Bank Account Holder:

Bank Routing Number

(U.S. banks only)

(must provide copy of a voided check)

Bank Account Number

(U.S. banks only)

(must provide copy of a voided check)

Name (of authorized user):

Signature (of authorized user):

Contact Telephone Number:

Contact E-mail Address:

Submit this completed form to the Deposit Account Branch by email to

RADHelpdesk@uspto.gov

(preferred) or by fax at (571) 273-6500.

Finance Use Only

Date of

_______________

Date to

_______________

Refund

_______________

Last Sale:

Close Account:

Approved By:

P.O. Box 1450, Alexandria, Virginia 22313-1450

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Form Pto-2234 - Deposit Account Closure Request Form - U.s. Patent And Trademark Office