Form Pd F 5180 E - Reinvestment Request

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OMB No. 1535-0069

PD F 5180 E

Department of the Treasury

Legacy Treasury Direct

Bureau of the Public Debt

(Revised June 2008)

REINVESTMENT REQUEST

1-800-722-2678

SEE INSTRUCTIONS - TYPE OR PRINT IN INK ONLY - NO ALTERATIONS OR CORRECTIONS

1. Legacy Treasury Direct ACCOUNT INFORMATION

FOR DEPARTMENT USE

You will find this information on your Statement of Account.

Legacy Treasury Direct ACCOUNT NUMBER

DOCUMENT AUTHORITY

ACCOUNT NAME

APPROVED BY

DATE APPROVED

Have You Tried Reinvest Direct ? It’s Easy!

To make a full reinvestment of your maturing securities, try our

phone (1-800-722-2678) or web services ( ).

CUSIP

2. SCHEDULING

Reinvesting a BILL? Choose left column. Reinvesting a NOTE? Choose right column.

BILL REINVESTMENT

NOTE REINVESTMENT

REINVEST

FOR

13 WEEKS

TIMES

REINVEST

(FROM 1-8)

YEARS

FOR

AMOUNT

FOR

26 WEEKS

TIMES

(FROM 1-4)

REINVEST THE SUB-ACCOUNTS SHOWN BELOW.

(Use this option ONLY when specifying SUB-ACCOUNTS.)

52 WEEKS

FOR

TIMES

SUB-

(FROM 1-2)

AMOUNT

TERM

ACCOUNT

REINVEST THE SUB-ACCOUNTS SHOWN BELOW.

(Use this option ONLY when specifying SUB-ACCOUNTS.)

YEARS

TERM

NUMBER OF

SUB-

AMOUNT

(13, 26, or 52)

REINVESTMENTS

ACCOUNT

YEARS

WEEKS

YEARS

WEEKS

YEARS

WEEKS

SPECIAL NOTICE (for NOTES only):

If the term you

Then you may

As long as the reinvestment option you choose is issued on or within

have chosen is . . .

schedule up to . . .

five calendar days of your security’s maturity date, we can reinvest your

13 WEEKS

8 REINVESTMENTS

funds with no problem. We simply place your money in a non-interest

bearing account until the new security’s issue date. More than a five-

26 WEEKS

4 REINVESTMENTS

day delay? We refund your money when your current security matures.

52 WEEKS

2 REINVESTMENTS

3. CANCELING

ALL REINVESTMENTS.

REINVESTMENTS ONLY FOR THE SUB-ACCOUNTS SHOWN HERE:

4. AUTHORIZATION

I submit this request pursuant to the provisions of Department of the Treasury Circulars, Public Debt Series Nos. 2-86 (31 CFR Part 357) and 1-93 (31 CFR Part 356), and

the applicable offering announcement. Under penalties of perjury, I further certify that all other information provided on this form is true, correct and complete.

Signature(s)

Title (if appropriate)

Date

Telephone

SEE INSTRUCTIONS FOR PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE

(OVER)

RESET