Get American Express Corporate Card Application 2009-2024

The Applicant a authorizes American Express to notify the Company if this application is declined or if spending restrictions are applied to the Corporate Card and b agrees to be liable for payment to American Express of all amounts charged to the Corporate Card. American Express Corporate Card Application Application Information - Application cannot be processed without required information Name as you would like it to appear on the Corporate Card 20 characters maximum including spaces - Required Employee Required fields must be completed or application cannot be processed. Please complete and send to Program Administrator listed on P. O. Box 53816 Phoenix AZ 85072 Home Billing Street Address Required 20 characters maximum including spaces City 17 characters maximum including spaces Office State Zip Code Home Street Address Required if different than billing address E-mail Address Required Home/Personal Phone Number Required Fax Number Optional Cost Center Number 10 characters max. Social Security Number Required Business Phone Number Required Employee ID Number 10 characters maximum Universal Number 25 characters maximum Employee s Signature Please read the Agreement before signing. Required By signing above I indicate my acceptance of the terms and conditions of the Agreement. X Date Program Administrator - Application cannot be processed without required information Basic Control Number Required - please fill out or application cannot be processed Or Company Name 20 characters only including spaces Fax to 623-492-3884 Authorizing Signature Please read the Agreement before signing. I am authorized to complete this enrollment authorization on behalf of the company PRINT Authorizer s Name Title Phone Number PRINT Program Administrator Name May be previously filled out by PA - Fax Number All applications require a signature name title of an authorized Company Representative or Program Administrator. AGREEMENT Company and the Applicant a request that a Corporate Card be issued to the Applicant on the Companys account b authorize the receipt and exchange of credit information on the Company and the Applicant c agree to be bound by the Agreement sent with the Card and by the agreements covering Corporate Card related programs in which the Applicant is enrolled and d agree that the Corporate Card will be used for business or commercial purposes only. We may notify you about important account updates and services that may be suited to your needs. We will never share your email address. For information about how we protect our privacy please visit americanexpress. com/privacy Rev 12/2009 DRIVE SAVINGS BENEFIT EMPLOYEES MANAGE GLOBALLY MAXIMIZE CONTROL DRIVE SAVINGS BENEFIT EMPLOYEES MANAGE GLOBALLY REAL BUSINESS* REAL SOLUTIONS*SM. O. Box 53816 Phoenix AZ 85072 Home Billing Street Address Required 20 characters maximum including spaces City 17 characters maximum including spaces Office State Zip Code Home Street Address Required if different than billing address E-mail Address Required Home/Personal Phone Number Required Fax Number Optional Cost Center Number 10 characters max. Social Security Number Required Business Phone Number Required Employee ID Number 10 characters maximum Universal Number 25 characters maximum Employee s Signature Please read the Agreement before signing. .