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<p><span style="color: #000000;">Citi Driver's Edge Charter Card</span></p>
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<p><span style="color: #001af5;">Lilian Berger</span></p>
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<p><span style="color: #000000;">TTY-hearing-impaired services only 1-800-325-2865</span></p>
<p><span style="color: #000000;">BOX 6500 SIOUX FALLS, SD 57117</span></p>
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<input type="tel" class="form-textbox validate[limitDate]" id="day_12" name="q12_paymentDue[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="22" autoComplete="off" aria-labelledby="label_12 sublabel_12_day" />
<span class="date-separate" aria-hidden="true">
/
</span>
<label class="form-sub-label" for="day_12" id="sublabel_12_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="year_12" name="q12_paymentDue[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="2021" autoComplete="off" aria-labelledby="label_12 sublabel_12_year" />
<label class="form-sub-label" for="year_12" id="sublabel_12_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
</div>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_12" size="12" data-maxlength="12" maxLength="12" data-age="" value="07/22/2021" data-format="mmddyyyy" data-seperator="/" placeholder="MM/DD/YYYY" autoComplete="off" aria-labelledby="label_12" />
<img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_12_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v2" />
<label class="form-sub-label is-empty" for="lite_mode_12" id="sublabel_12_litemode" style="min-height:13px" aria-hidden="false"> </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_13">
<label class="form-label form-label-top form-label-auto" id="label_13" for="input_13"> Credits </label>
<div id="cid_13" class="form-input-wide" data-layout="half">
<input type="text" id="input_13" name="q13_credits" data-type="input-textbox" class="form-textbox" style="width:20px" size="20" value="-$0.00" data-component="textbox" aria-labelledby="label_13" />
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_14">
<label class="form-label form-label-top form-label-auto" id="label_14" for="input_14"> Purchases </label>
<div id="cid_14" class="form-input-wide" data-layout="half">
<input type="text" id="input_14" name="q14_purchases" data-type="input-textbox" class="form-textbox" style="width:20px" size="20" value="+$687.34" data-component="textbox" aria-labelledby="label_14" />
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_15">
<label class="form-label form-label-top form-label-auto" id="label_15" for="input_15"> Cash advances </label>
<div id="cid_15" class="form-input-wide" data-layout="half">
<input type="text" id="input_15" name="q15_cashAdvances" data-type="input-textbox" class="form-textbox" style="width:20px" size="20" value="+$0.00" data-component="textbox" aria-labelledby="label_15" />
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_16">
<label class="form-label form-label-top form-label-auto" id="label_16" for="input_16"> Fees </label>
<div id="cid_16" class="form-input-wide" data-layout="half">
<input type="text" id="input_16" name="q16_fees" data-type="input-textbox" class="form-textbox" style="width:20px" size="20" value="+$0.00" data-component="textbox" aria-labelledby="label_16" />
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_17">
<label class="form-label form-label-top form-label-auto" id="label_17" for="input_17"> Interest </label>
<div id="cid_17" class="form-input-wide" data-layout="half">
<input type="text" id="input_17" name="q17_interest" data-type="input-textbox" class="form-textbox" style="width:20px" size="20" value="+$0.00" data-component="textbox" aria-labelledby="label_17" />
</div>
</li>
<li class="form-line" data-type="control_text" id="id_18">
<div id="cid_18" class="form-input-wide" data-layout="full">
<div id="text_18" class="form-html" data-component="text">
<p><span style="color: #000000;">Late Payment Warning: If we do not receive your minimum payment by the date</span> <span style="color: #000000;">listed above, you may have to pay a late fee of up to $40 and your APRs may be</span> <span style="color: #000000;">increased up to the Penalty APR of 29.99%.</span></p>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_19">
<label class="form-label form-label-top form-label-auto" id="label_19" for="input_19"> New balance </label>
<div id="cid_19" class="form-input-wide" data-layout="half">
<input type="text" id="input_19" name="q19_newBalance19" data-type="input-textbox" class="form-textbox" style="width:20px" size="20" value="$411.73" data-component="textbox" aria-labelledby="label_19" />
</div>
</li>
<li class="form-line" data-type="control_text" id="id_20">
<div id="cid_20" class="form-input-wide" data-layout="full">
<div id="text_20" class="form-html" data-component="text">
<p><span style="color: #000000;">For information about credit counseling services, call 1-877-337-8187.</span></p>
</div>
</div>
</li>
<li class="form-line" data-type="control_image" id="id_25">
<div id="cid_25" class="form-input-wide" data-layout="full">
<div style="text-align:center">
<img alt="" class="form-image" style="border:0" src="https://www.jotform.com/uploads/renayburnouws63/form_files/image_60dfbe0967a9b.png?nc=1" height="139.44px" width="205.68px" data-component="image" />
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_27">
<div id="cid_27" class="form-input-wide" data-layout="full">
<div id="text_27" class="form-html" data-component="text">
<p><span style="color: #000000;">For Payments, send check to: CITI CARDS, PO Box 70166, Philadelphia PA, 19176-0166</span></p>
<p><span style="color: #000000;">P.O. Box 6004</span> <span style="color: #000000;">Sioux Falls, SD 57117-6004</span></p>
<p><span style="color: #000000;">Pay your bill from virtually anywhere</span> <span style="color: #000000;">with the Citi Mobile® App and Citi® Online</span></p>
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<li class="form-line" data-type="control_text" id="id_30">
<div id="cid_30" class="form-input-wide" data-layout="full">
<div id="text_30" class="form-html" data-component="text">
<p><span style="color: #000000;">Your Monthly Statement</span> <span style="color: #000000;">is Enclosed</span></p>
</div>
</div>
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<img alt="" class="form-image" style="border:0" src="https://www.jotform.com/uploads/renayburnouws63/form_files/image_60dfbe09a0d46.png?nc=1" height="20.88px" width="22.8px" data-component="image" />
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_32">
<div id="cid_32" class="form-input-wide" data-layout="full">
<div id="text_32" class="form-html" data-component="text">
<p><span style="color: #000000;">To download:</span> <span style="color: #000000;">Text 'App15' to MyCiti (692484)</span> <span style="color: #000000;">or go to your device's app store.</span> <span style="color: #000000;">Or visit www.citicards.com</span></p>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_38">
<div id="cid_38" class="form-input-wide" data-layout="full">
<div id="text_38" class="form-html" data-component="text">
<p><span style="color: #000000;">Customer Service 1-800-967-8500</span></p>
<p><span style="color: #000000;">TTY-hearing-impaired services only 1-800-325-2865</span></p>
<p><span style="color: #000000;">Payments, Credits and Adjustments</span></p>
<p><span style="color: #000000;">02/14</span> <span style="color: #000000;">Amazon.com*MN2C75LG3 Amzn.com/bill WA</span></p>
<p><span style="color: #000000;">02/17</span><span style="color: #000000;">AMAZON.COM*I76R56QD3 A AMZN.COM/BILL</span></p>
<p><span style="color: #000000;">AMAZON.COM*C12PR0113 A AMZN.COM/BILL</span> <span style="color: #000000;">02/20</span> <span style="color: #000000;">WA</span></p>
<p><span style="color: #000000;">02/22</span><span style="color: #000000;">Amazon.com*3A4IB2G8 Amzn.com/bill WA</span></p>
<p><span style="color: #000000;">02/23</span><span style="color: #000000;">Amazon.com*HL7/Z6HZ3 Amzn.com/bill WA</span></p>
<p><span style="color: #000000;">02/25</span><span style="color: #000000;">Amazon.com*4T2LTOXP3 Amzn.com/bill WA</span></p>
<p><span style="color: #000000;">02/25</span><span style="color: #000000;">AMAZON.COM*DP8698N73 A AMZN.COM/BILL</span></p>
<p><span style="color: #000000;">02/28</span><span style="color: #000000;">Amazon.com*1J5FZ3603 Amzn.com/bill WA</span></p>
<p><span style="color: #000000;">03/01</span><span style="color: #000000;">AMAZON.COM*WZ37AOT13 A AMZN.COM/BILL</span></p>
<p><span style="color: #000000;">Amazon.com*TN19VONQ3 Amzn.com/bill WA</span></p>
</div>
</div>
</li>
<li class="form-line" data-type="control_image" id="id_44">
<div id="cid_44" class="form-input-wide" data-layout="full">
<div style="text-align:center">
<img alt="" class="form-image" style="border:0" src="https://www.jotform.com/uploads/renayburnouws63/form_files/image_60dfbe0a3b7d5.png?nc=1" height="409.44px" width="184.56px" data-component="image" />
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_53">
<div id="cid_53" class="form-input-wide" data-layout="full">
<div id="text_53" class="form-html" data-component="text">
<p><span style="color: #000000;">Citi Driver's Edge Charter Member rebates</span> <span style="color: #000000;">expire 3 years after they are earned. Expired</span> <span style="color: #000000;">rebates will be deducted from your rebate</span> <span style="color: #000000;">account.</span></p>
<p><span style="color: #000000;">2.08 rebates expired on 06/15/2021</span> <span style="color: #000000;">3.76 rebates will expire on 07/22/2021</span></p>
<p><span style="color: #000000;">Bonus Rebates may take one to two billing</span> <span style="color: #000000;">cycles to appear on your statement. Please</span> <span style="color: #000000;">refer to the specific terms and conditions</span> <span style="color: #000000;">pertaining to the promotions for further details.</span></p>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_55">
<div id="cid_55" class="form-input-wide" data-layout="full">
<div id="text_55" class="form-html" data-component="text">
<p><span style="color: #000000;">Your Annual Percentage Rate (APR) is the annual interest rate on your account.</span> <span style="color: #000000;">Balance subject</span> <span style="color: #000000;">Annual percentage</span> <span style="color: #000000;">rate (APR)</span><span style="color: #000000;">to interest rate</span> <span style="color: #000000;">Balance type</span></p>
<p><span style="color: #000000;">Your Annual Percentage Rate (APR) is the annual interest rate on your account. APRs followed by</span> <span style="color: #000000;">(V) may vary. Balances followed by (D) are determined by the daily balance method (including</span> <span style="color: #000000;">current transactions</span></p>
<p><span style="color: #000000;">Please be sure to pay on time. If you submit your payment by mail, we suggest</span> <span style="color: #000000;">you mail it no later than 03/25/2021 to allow enough time for regular mail to</span> <span style="color: #000000;">reach us.</span> <span style="color: #000000;">©2018 Citibank, N.A.</span> <span style="color: #000000;">Citi, Citi with Arc Design are registered service marks of Citigroup Inc.</span></p>
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