Credit Card Application with Bonus Features on Using Card
Are you already an owner (or holder) of a _____________________ (Name of Card) ?
[ ] Yes [ ] No
If yes, the credit card application will be shorter.
Would you prefer to earn cash back on your purchases? Then apply for ____________
_______________ (Name of Card) ?
First Name: _________________________ Last Name: ______________________
Middle Initial: _______ Name on Card: ___________________
Home Street Address: _____________________________________________
Home Apt/Suite Number: __________
Home Zip Code: ______________ Home Phone Number: _____________
Do you: [ ] Own? [ ] Rent? E-mail Address: __________________
Social Security Number: ______________________________
Date of Birth: Month __________ Day _________ Year ____________
Employer Name: ______________________________________________
Employer Phone Number: ____________________________________________
Employer City: ________________________ Employer State: _________________
If under the age of 21, provide total annual salary and other income you receive. All
applicants: Alimony, child support, or separate maintenance need not be revealed if you
do not wish to rely upon it.
Annual Household Income: $________________ Income Source:________________
Do you have a (check all that apply):
[ ] Checking Account? [ ] Money Market/Savings?
Additional Cards
You may a dd someone to your account with no annual fee. A dditional Cardmember
charges are itemized and separated on your regular monthly statement. If your Card or
the Additional Card is lost or stolen, only that Card needs to be replaced because each
Card has its own number. The Additional Cardmember must be 15 or older, and must
never have had a defaulted account with _____________________ (Name of Card) .
First Name: ____________________ Last Name __________________________
Date of Birth: ___________________ Social Security Number: _______________
Transfer Balances
Minimum transfer amount is $100 up to your available line of credit. Maximum transfer
amount for each of the 4 transfer requests is $25,000 depending on the available line of
credit. Please continue paying the current minimum payment on your existing account
until the transfer appears on your new American Express Credit Card account. If your
request exceeds your available credit line or amount approved, the transfer request may
be honored and processed in part for a lower amount than requested, or the transfer
request may be declined. Balances may not be transferred from any other account
issues by American Express or any of its affiliates. Please see the terms, conditions
and disclosures for complete details.
The _____________________ (Name of Card) ACCOUNT PROTECTOR PROGRAM:
[ ] Yes! I want to protect my account by enrolling in the OPTIONAL _______________
___________ (Name of Card) Account Protector Program from __________________
(Name of Card) . I have read the Program Summary (see Terms & Conditions) and
understand that enrollment in the Account Protector Program is not required to obtain
credit and that I may cancel at any time. For each month's protection, bill my account
the fee of $0.85 per $100 of my month end account balance. PLEASE SCROLL DOWN
TO READ IMPORTANT INFORMATION ABOUT RATE, FEE, AND OTHER COST
INFORMATION BEFORE SUBMITTING YOUR APPLICATION.
By submitting this application, I certify that I have read, met and agreed to all the terms,
conditions and disclosures which contain rate, fee and other important information. I
understand that I will be enrolled in the ____________________ (Name of Program)
Membership Rewards program, and that ____________________ (Name of Program)
will receive certain information about me in order to provide the benefits of my
Membership Rewards account.
IMPORTANT INFORMATION REGARDING RATES, FEE, AND OTHER COST
INFORMATION
Interest Rates and Interest Charges 0.0% introductory APR for the first 6 months
Annual Percentage Rate
(APR) for Purchases
After that, your APR will be 15.24, 17.24 or
19.24% based on your creditworthiness as
determined at the time of account opening.
This APR will vary with the market based on
the Prime Rate.
APR for Balance Transfers 15.24, 17.24 or 19.24% I ntroductory APR on
balance transfers requested within 30 days of
account opening.
After that, your APR for those transactions and
any other balance transfer requests, if we
accept them, will be 15.24, 17.24 or 19.24%
based on your creditworthiness.
APR for Cash Advances 25.24%
This APR will vary with the market
based on the Prime Rate
Penalty APR for Cash Advances
and When it Applies 27.24%
This APR will vary with the market
based on the Prime Rate.
This APR will apply to your account if
you:
1) Make one or more late payments; or
2) Make a payment that is returned.
How Long Will the Penalty APR
Apply? If the Penalty APR is applied for
any of these reasons, it will apply for at
least 12 billing periods in a row, and will
continue to apply until after you have
made timely payments, with no returned
payments, for 12 billing periods in a row.
Paying Interest Your due date is at least 25 days after
the close of each billing period. We will
not charge you interest on purchases if
you pay your entire balance by the due
date each month. We will begin
charging interest on cash advances and
balance transfers on the transaction
date.
For Credit Card Tips from the
Federal Reserve Board To learn more about factors to consider
when applying for or using a credit card,
visit the website of the Federal Reserve
Board at
http://www.federalreserve.gov/creditcard
Fees
Annual Membership Fee: $__________________
Additional Card Fee: $__________________
Transaction Fees
Balance Transfer: Either $5 or 3% of the amount of each transfer,
whichever is greater.
Cash Advance: Either $5 or 3% of the amount of each cash
advance, whichever is greater.
Foreign Transaction: 2.7% of each transaction after conversion to
US dollars.
Penalty Fees
Late Payment: $19 if balance is less than $250; $39 if balance
is $250 or more
Returned Payment: $ __________
How We Will Calculate Your Balance: We use a method called "average daily
balance (including new purchases)."
Loss of Introductory APR: We may end any Introductory APR and apply the Penalty
APR if you make a late payment.
Variable APRs for each billing period are based on the Prime Rate published in The
Wall Street Journal 2 days before the Closing Date of the billing period. The Wall Street
Journal may not publish the Prime Rate on that day. If it does not, we will use the Prime
Rate from the previous day it was published. If the Prime Rate increases, variable APRs
will increase. In that case, you may pay more interest and have a higher Minimum
Payment Due. When the Prime Rate changes, the resulting changes to variable APRs
take effect as of the first day of the billing period. Variable APRs are accurate as of
05/15/10.
TERMS AND CONDITIONS
By submitting this application, you are requesting us to open an Account in your name
and to issue Card(s) as you direct. Only qualified individuals 18 or over may apply for an
Account. This offer is available to US Residents, excluding Puerto Rico and the US
Virgin Islands.
You promise that the information you provide on this application is accurate. You
authorize us to verify this information and to obtain reports from consumer reporting
agencies. You authorize us and our affiliates and subsidiaries to share information we
have about you at any time for marketing and administrative purposes as permitted by
law. Upon request, we will tell you if we have received a consumer report and the name
and address of the agency that provided it.
When you use your Account (or sign or keep the Card), you agree to the terms of the
Cardmember Agreement that will be provided to you. Your Cardmember Agreement
includes an arbitration provision, which impacts your opportunity to have claims
related to the account heard in court or resolved by a jury, and to participate in a
class action or similar proceeding. You are responsible for all use of your account,
including use of your Account by Additional Cardmembers and anyone you or they allow
to use your Account.
We may change the terms of, or add new terms to, the Cardmember Agreement at any
time, subject to applicable law. We may apply any changed or new terms to any existing
and future balances on your Account, subject to applicable law.
Additional Cards: You must notify Additional Cardmembers that we may obtain,
provide, and use information about them and that their use of your Account is subject to
certain provisions of the Cardmember Agreement. We may seek payment from
Additional Cardmembers for Charges they make or authorize if you do not pay us.
Patriot Act Notice: Federal law requires all financial institutions to obtain, verify and
record information that identifies each person who opens an account, including your
name, address, date of birth and other information that will allow us to verify your
identity.
Balance Transfers: We will debit your Card account for the total approved balance
transfer amount. A balance transfer request will be declined if the requested amount
plus fees exceeds your available credit line. Total balance transfers cannot exceed
$25,000 in a 180-day period. We will not initiate any balance transfers until at least ten
days after we have mailed or otherwise provided the Cardmember Agreement to you. In
some cases, it may take up to six weeks to complete a balance transfer. Please be sure
to make all minimum payments on any account from which you are transferring a
balance until the balance transfer is credited to that account. You are responsible for
maintaining those accounts in good standing and for closing them if you choose. You
authorize us to verify the status and balance of those accounts. You cannot transfer
balances from any other account issued by American Express or its affiliates. Additional
Cardmembers may not request or authorize balance transfers. We reserve the right to
deny a balance transfer request for any reason.
Witness my signature this the _____ day of _____________, 20______.
_____________________________
(Printed Name of Applicant)
_____________________________
(Signature of Applicant)
Bonus Plans
1. To be eligible to earn bonus points in the ______________________ (name of
program) website, you must be a U.S. Cardmember and enrolled in the ____________
__________________ (name) program at the time of purchase and you must charge
your qualifying purchase through the _____________________ (name of program)
website __________________________ (address of site) on an eligible, enrolled
____________________ (Name of Card) Card. Bonus points are awarded for all
qualifying transactions at participating merchants through the _____________________
(name of program) website. Participating merchants are subject to change without
notice. Additional terms and conditions apply and appear on the __________________
(name of program) website. Bonus points will be credited to your Program account
within 6-8 weeks after charges appear on your billing statement. Bonus ID: __________
(number) .
2. To be eligible to earn double points, you must be enrolled in the _____________
______________ (name of program) , hereinafter called the Program , at the time of
purchase and you must charge your air, Lowest Rates Guaranteed hotel, Complete Trip
(flight + hotel packages), _______________________ (Name of Card) Vacations
package and cruise reservations on an eligible, enrolled _______________________
(Name of Card) through _______________________________ (address of website) .
Any portion of a charge that you elect to pay through redemption of ________________
____________ (name of program) Rewards points is not eligible to earn points. Bonus
ID ______________ (number) . Bonus points will be credited to your program account
10-12 weeks after final payment has been made. Some ____________________
(Name of Card) Cards are not eligible for enrollment in the program. Terms and
Conditions for the _________________ (name of program) Rewards program apply.
For more information on the ____________________ (name of program) Rewards
program, visit __________________________ (address of website) or
__________________________ (address of website) or call ____________________
(phone number) . Participating partners and available rewards are subject to change
without notice.
3. Terms and Conditions for the ____________________ (name of program)
Membership program apply. Visit _____________________________ (address of
website) or call ___________________ (phone number) for more information.
Participating partners and available rewards are subject to change without notice.
A. ______________________ (Name of Card) Return Protection provides
product satisfaction on designated items purchased entirely with an eligible
________________________ (Name of Card) . If you try to return a designated
item within 90 days from the date of purchase and the merchant won’t take it
back, ____________________ (Name of Card) may refund the full purchase
price, up to $300 per item, excluding shipping and handling, up to a maximum of
$1,000 annually per Card account. Call ______________________ (phone
number) within 90 days of the purchase date to notify us of your request.
Coverage is subject to additional terms, conditions and exclusions.
B. ____________________ (Name of Card) Extended Warranty is
underwritten by ___________________________________________________
______________________________________________________ (name and
address of company) . Coverage is determined by the terms, conditions, and
exclusions of Policy ___________ and is subject to change with notice. This
document does not supplement or replace the Policy.
C. ___________________ (Name of Card) Purchase Protection is
underwritten by ___________________________________________________
________________________________________________________________
(name and address of company) . Coverage is determined by the terms,
conditions, and exclusions of Policy ____________ and is subject to change with
notice. This document does not supplement or replace the Policy.
D. _______________________ (Name of Company) acts solely as sales
agent for travel suppliers and is not responsible for the actions or inactions of
such suppliers. We want you to be aware that certain suppliers pay us
commissions and other incentives, and may also provide incentives to our travel
counselors.
E. Car Rental Loss and Damage Insurance is underwritten by ____________
________________________________________________________________
___________________________________ (name and address of company) .
Coverage is determined by the terms, conditions, and exclusions of Policy
___________ and is subject to change with notice. This document does not
supplement or replace the Policy.
F. Travel Accident Insurance is underwritten by _______________________
________________________________________________________________
____________________________________ (name and address of
company) . Coverage is determined by the terms, conditions, and exclusions of
Policy ____________ and is subject to change with notice. This document does
not supplement or replace the Policy.
G. Not all services are available at all locations and all are subject to local
laws and cash availability.
H. Charges processed and posted to your account after ________________
(date) will appear on next year’s summary.
Account Protector Program from _____________________ (Name of Card)
Terms and Conditions
Read these Terms and Conditions carefully because Debt Cancellation will not
begin unless and until You have satisfied the requirements specified herein.
In these Terms and Conditions, "Program" means the Account Protector Program from
___________________ (Name of Card) , "You" or "Your" means the _______________
___________ (Name of Card) Cardmember; it does not include holders of
supplemental ___________________ (Name of Card) . "Account" means Your
_______________________ (Name of Card) Card Account specified in this Welcome
Package. "We," "Ours" and "Us" mean _______________________ (Name of Card) or
its participating subsidiaries. "Vendor" shall mean the entity performing administrative
services on Our behalf. "Enrollment Date" shall mean the date Your request for
enrollment in the Program is accepted and processed by Us.
1. Product Description : Enrollment in the Program is an optional feature of Your
Account. In return for a Fee (as defined in Section 12 below and subject to these Terms
and Conditions), in the event of a Qualifying Event (defined below), We will cancel part
or all of Your Account Balance as of the Qualifying Event (as defined below).
Cancellation of part or all of Your Account Balance as of the Qualifying Event under the
Program is referred to as "Debt Cancellation". "Account Balance as of the Qualifying
Event" means the total amount outstanding on Your Account on the first day of the
Qualifying Event. "Qualifying Event" means, separately and collectively, Involuntary
Unemployment, Disability, Hospitalization, Leave of Absence, Death, or Life Event
(each as defined below). These Terms and Conditions describe the specific
circumstances which constitute a Qualifying Event, what You must do to verify that You
qualify for a Debt Cancellation, and how long each Debt Cancellation will or may remain
in effect (a "Debt Cancellation Period"). This Program is not insurance. During a Debt
Cancellation Period, Your Account will still be subject to fees and charges as provided
for in the Cardmember Agreement.
General Debt Cancellation Requirements. In order to qualify for Debt Cancellation,
You must report Your Qualifying Event within 90 days of the first day of the Qualifying
Event. Debt Cancellation for Involuntary Unemployment, Disability, Hospitalization,
Leave of Absence and Life Events is limited to 2.5% of Your Account Balance as of the
Qualifying Event per month during the Debt Cancellation Period with a minimum Debt
Cancellation of $15 and a maximum Debt Cancellation of $500 per month during the
Debt Cancellation Period. Debt Cancellation for Death is limited to Your Account
Balance as of the Qualifying Event up to a maximum of $10,000. If You qualify for
Involuntary Unemployment, Disability, or Leave of Absence for a partial month, a Debt
Cancellation will be calculated and applied to Your Account on a daily basis as 1/30th of
Your Account Balance as of the Qualifying Event for each day of the applicable month
for which You qualify for the applicable Qualifying Event. You are not eligible for Debt
Cancellation under more than one Qualifying Event at any time. You will not be eligible
for Debt Cancellation for a Qualifying Event that begins prior to or on Your Enrollment
Date.
2. Involuntary Unemployment
A. Involuntary Unemployment. "Involuntary Unemployed" means that You
suffer an entire loss of salary income due to the involuntary loss of employment.
The following are examples of occurrences that do not qualify as Involuntary
Unemployment: (a) voluntary forfeiture of employment or income; (b) resignation;
(c) retirement; (d) scheduled termination of an employment contract; (e)
termination for cause; (f) termination due to willful or criminal misconduct; or (g) if
You are self-employed, unemployment due to the dissolution or temporary
cessation of business.
B. Qualification for Involuntary Unemployment. To qualify for a Debt
Cancellation for Involuntary Unemployment (a) You must have been continuously
employed for 30 consecutive days immediately preceding the first day of the
Qualifying Event for at least 30 hours per week by someone other than Yourself
or another member of Your household, and the employment must have been
considered to be permanent; (b) You must qualify for state unemployment
benefits; and (c) You must register for work at a state employment office or a
recognized employment agency. After You have been Involuntarily Unemployed
for 14 consecutive days and subject to these Terms and Conditions, We will
cancel an amount equal to 2.5% of Your Account Balance as of the Qualifying
Event for each month You remain involuntarily unemployed. The maximum Debt
Cancellation Period for Involuntary Unemployment is twenty four (24) months per
occurrence. During Your Debt Cancellation Period, You must provide evidence of
Your continued Involuntary Unemployment each month by demonstrating Your
continued registration with a state employment office or recognized employment
agency.
3. Disability
A. Disability. "Disabled" means that You are completely prevented from
performing the duties of Your regular occupation (at the time of the disability) as
a result of an accident or illness and You are under the continuous treatment of a
Physician who will verify same. "Physician" means a person licensed by a state
of the United States to treat the condition resulting in Your request for Debt
Cancellation and who is practicing medicine within the scope of such license.
B. Qualification for Debt Cancellation . After You have been Disabled for
14 consecutive days and subject to these Terms and Conditions, We will cancel
an amount equal to 2.5% of Your Account Balance as of the Qualifying Event for
each month you remain disabled. The maximum Debt Cancellation Period for
Disability is twenty four (24) months per occurrence. After the initial Request for
Benefits form has been furnished, You must provide evidence of Your continued
Disability each month with Our form which must be completed by a Physician
confirming Your medical condition.
C. Exclusions. The Disability Qualifying Event excludes normal pregnancy,
intentionally self inflicted injuries or pre-existing conditions. Pre-existing condition
means a disability that occurred on or prior to Your Enrollment Date.
4. Hospitalization
A. Hospitalization . "Hospitalized" means that You are admitted to a Hospital
due to a medical condition and are required to stay 2 consecutive nights in the
Hospital. The term "Hospital" includes any licensed medical hospital, chiropractic
hospital, acute care, convalescent nursing, residential drug rehabilitation,
psychiatric or hospice facility.
B. Qualification for Debt Cancellation . If You are Hospitalized; subject to
these Terms and Conditions We will cancel an amount equal to 2.5% of Your
Account Balance as of the Qualifying Event. The maximum Debt Cancellation
Period for Hospitalization is one (1) month per occurrence.
C. Exclusions. The Hospitalization Qualifying Event excludes normal
pregnancy, intentionally self inflicted injuries or Pre-existing Conditions. A "Pre-
existing Condition" means a condition that was diagnosed or treated on or prior
to Your Enrollment Date.
5. Leave of Absence
A. Leave of Absence. "Leave of Absence" means an employer approved
temporary absence from permanent, full time employment without pay for at least
30 consecutive days. The following are examples of occurrences that do not
qualify as a Leave of Absence: (a) resignation; (b) retirement; (c) absence from
work due to sickness, illness, disease, accident, injury or pregnancy; (d)
scheduled termination of Your employment contract; (e) termination for cause; (f)
termination due to willful or criminal misconduct; or (g) if You are self-employed,
Leave of Absence due to the dissolution or temporary cessation of business.
B. Qualifications. To qualify for Debt Cancellation due to a Leave of
Absence (a) You must have been continuously employed by someone other than
Yourself or another member of Your household for 30 consecutive days
immediately preceding the first day of the Qualifying Event for at least 30 hours
per week; (b) Your employment must have been considered permanent; and (c)
You must obtain a letter from Your employer stating that You have been granted
an unpaid Leave of Absence from work stating the reason for the Leave of
Absence and the duration. If You qualify for Debt Cancellation due to a Leave of
Absence, subject to these Terms and Conditions We will cancel 2.5% of Your
Account Balance as of the Qualifying Event. The maximum length of Your Debt
Cancellation Period for a Leave of Absence is three (3) months per occurrence.
6. Death
A. Qualifications. To qualify for a Debt Cancellation due to Death Your
Death must occur after Your Enrollment Date and Your next of kin must submit a
certified copy of Your Death Certificate to Us. If You qualify for Debt Cancellation
due to Death, subject to these Terms and Conditions We will cancel Your
Account Balance as of the Qualifying Event, up to a maximum of $10,000.
B. Exclusions. Excludes Death caused by suicide, nuclear disaster, war or
any act of war, or unscheduled air flight.
7. Life Events
A. Life Events . A Life Event means that You experience one of the following
events while enrolled in the Program and within 90 days of the occurrence of the
Life Event You provide evidence acceptable to Us of its occurrence:
Marriage - copy of Marriage Certificate
Birth of Your Child - copy of Birth Certificate
Your Adoption of child(ren) - copy of Court Orders
Relocation of more than 150 miles from your residence - Lease
Agreement or Utilities notice
Call to Active Duty by U.S. military - copy of Orders from Military branch
Loss of Spouse - copy of death certificate
Purchase of Your New Home - copy of escrow closing document
Divorce - copy of Court Orders
Starting College - copy of Your class schedule or class enrollment
B. Qualifications. To qualify for Debt Cancellation due to a Life Event You
must submit proof as described above or other proof of the event as deemed
satisfactory by Us. If You qualify for Debt Cancellation due to a Life Event,
subject to these Terms and Conditions We will cancel 2.5% of Your Account
Balance as of the Qualifying Event.
C. Limitations or Exclusions. You are eligible for two (2) Debt
Cancellations due to a Life Event in any twelve (12) month period but only one
(1) Debt Cancellation due to a Life Event within any two (2) month period. You
are eligible for only one (1) Debt Cancellation due to Starting College.
8. Request for a Debt Cancellation
A. The initial request for a Debt Cancellation may be made by telephoning
the __________________________ (name of program vendor) at
______________________ (phone number) . This initial request for Debt
Cancellation must be made within 90 days of the first day of the Qualifying
Event.
B. Debt Cancellation. After the initial phone call, Our Vendor will send You a
Request for Debt Cancellation Verification Form and a list of any other
documents You must submit. You must send Us a completed Verification Form
with all required documentation within 30 days of the date We mail the
Verification Form to You.
9 . Debt Cancellation
A. Before Debt Cancellation is Granted . Until You are notified that You
have been granted a Debt Cancellation, You must continue to make payments as
required in Your Cardmember Agreement.
B. When a Debt Cancellation Period Ends. The Debt Cancellation Period
will end upon the earliest to occur of: (1) the end of Your Disability, Involuntary
Unemployment, or Leave of Absence; (2) You reach the applicable maximum
Debt Cancellation Period; (3) You fail to provide the Verification Forms
confirming that You qualify (or continue to qualify) for the applicable Debt
Cancellation; (4) You file for bankruptcy; or (5) We discover that You intentionally
misrepresented to Us any information pertaining to Your request for Debt
Cancellation.
C. Conditions & Charges during Debt Cancellation Period. During Your
Debt Cancellation Period, Finance Charges will accrue on Your Account Balance
as of the Qualifying Event. You will still be subject to fees and charges as
provided for in the Cardmember Agreement. You will be responsible for payment
of any difference between the Minimum Amount Due on Your Account Statement
and the Debt Cancellation amount posted to Your Account.
10. Waiver of Requirements
We reserve the right to waive any of the requirements of these Terms and
Conditions, at Our sole discretion. If We do so, We will not be obligated to waive the
same requirement in any other situation or for any other Cardmember, and our waiver of
one or more requirements will not constitute a waiver of any other requirements.
11. Enrollment Cancellation
You or We may cancel Your enrollment in this Program at any time and for any
reason. If We cancel Your enrollment in the Program, We will provide You at least 30
days advance written notice at the address of record for Your Account. If You decide to
cancel Your enrollment in the Program, You must mail or fax Your written request to
cancel to our Vendor at the address provided in Section 13. After the next billing
statement following cancellation, You will no longer be charged Fees for the Program
and Your enrollment in the Program will terminate on the last day of the then current
billing cycle. If You notify our Vendor of Your request to cancel within 30 calendar days
of Your Enrollment Date You will not be responsible for any Fees associated with the
Program.
12. Program Fees
A monthly fee ("Fee") for the Program will be assessed for each billing cycle
while You are enrolled in the Program. The Fee is $0.85 per $100 of the Total
Outstanding Balance at the end of the applicable billing cycle less the Fee. The Fee will
be shown on Your Monthly Account Statement. Total Outstanding Balance means all
amounts, including without limitation all charges and fees, outstanding on Your Account.
13. Other
These Terms and Conditions amend and supplement the Cardmember
Agreement applicable to the Account ("Cardmember Agreement"). Except as
specifically amended or supplemented by these Terms and Conditions, all provisions of
the Cardmember Agreement remain in full force and effect. If You have specific
questions, please call or write to Our Account Protector Program Vendor. The Vendor
can be reached toll free at: _____________________ (phone number) . Written
correspondence and all other documentation should be sent via U.S. mail to:
______________________________________________________ (Name of
Program and Address) or via facsimile to ___________________ (Fax Number) .
Witness my signature this the _____ day of ______________, 20____.
_____________________________
(Printed Name of Applicant)
_____________________________
(Signature of Applicant)
