Balance Transfer Request Form

               BALANCE TRANSFER REQUEST FORM                  

DATE:    _______________

Account Number #                   _____________________________________________

Name of Company                  _____________________________________________

Amount to be Transferred      _____________________________________________

Payment Mailing Address       _____________________________________________

                                                     _____________________________________________

                                                     _____________________________________________

                                                     _____________________________________________

Cardholder’s Name:               ______________________________________________

Existing Credit Card #              ______________________________________________

(With Card Assets)

Cardholder’s Signature           ______________________________________________

Please return completed form to: CARD ASSETS

Fax: 770.805.2170

Scan and Email: [email protected]