X the PLATINUM CREDIT CARD from AMERICAN EXPRESS Form

THE PL ATINUM CREDIT CARD FROM AMERICAN E XPRESS Please print full name must not exceed 20 spaces. Spell your last name completely. Applicants must be residents of Canada* K72 V1 Please note that your current annual income must be at least 30 000. AAVPCRPDFE MBW A P P L I C AT I O N F O R M Home Address Apt. Date of Birth MM/DD/YYYY Yes Social Insurance Number optional City Province Providing social insurance number can expedite application process. No Self Employed Postal Code Email Address optional Employer Name Describe Occupation Home Phone / Year Personal Annual Income Business Phone Employer Address Cell Phone Optional B A L A N C E T R A N S F E R R E Q U E ST YES please transfer my account balance from my retail or financial institution card to my American Express Credit Card. I understand such transfer is subject to approval* Amount Name of Retail/Financial Institution Credit or Charge Card Account Number Minimum transfer amount 100. You may not transfer more than your available American Express credit limit* Please see Balance Transfer section for complete details. M AY W E S E N D YO U A F R E E S U P P L E M E N TA RY C A R D A. Name first middle initial last Same as Basic Applicant s Home Address Apt. City Province Postal Code Home Address Relationship to Basic Applicant PLEASE REVIEW THIS COMPLETE APPLICATION FORM TERMS AND CONDITIONS AND DISCLOSURE FOR IMPORTANT INFORMATION* By signing below you certify that you have read met and agreed to all the terms and conditions and disclosure included with this application* You acknowledge that the Consent to Use of Personal Information included with this application includes the sharing and exchange of reports and information about you with credit reporting agencies credit bureaus and others. P L E A S E S I G N B E LOW X BASIC CARD APPLICANT Date SUPPLEMENTARY CARD APPLICANT A To ensure that we get your application today please fax it to us at 1-800-306-8863. AAVPCRPDFE 02/08 DISCLOSURE as at 02/08 Purchases and Funds Advances Your applicable Annual Interest Rate will be If your Account Payment Record in the Review Period shows And will continue to apply as follows PREFERRED RATE 14. 99 for purchases and funds advances No more than one Missed Payment and You were at the Preferred Rate in the last Review Period or yo uare at the end of 12 billing periods in which the Standard Rate or Basic Rate applied Subject to your Account Payment Record in later Review Periods STANDARD RATE Two separate Missed Payments Whenever the Standard Rate or Basic Rate applies the rate will not be decreased for at least 12 billing periods from the effective date of the rate BASIC RATE One Missed Payment remains unpaid for two or more consecutive billing periods or Three or more separate Missed Payments Each billing period rate is subject to increase to the Basic Rate as determined by your Account Payment Record in the Review Period What Annual Interest Rate applies to Introductory Rate Offers for Balance Transfers and Other Special Rate Offers During the first 6 months of your Card membership only an introductory annual interest rate of 3. 99 applies to any balance transfers. We may but are not obligated to make other special rate offers at any time. If you have one Missed Payment at any time after the date that the first balance transfer or the first special rate offer transaction is posted to your account that introductory or special rate offer will be revoked* After the first 6 months of Card membership or after the special rate offer expires or if the introductory or special rate offer is revoked balance transfers or the balance that is subject to the special rate offer will be treated in the same way as purchases as set out above including the applicable annual interest rate that applies to purchases at that time. Definitions and Other Important Information At the end of each billing period we will review your Account Payment Record in the Review Period to determine your rate for the next billing period. Account Payment Record means your record of Missed Payments. Review Period means the 12 consecutive billing periods ending on the last day of the current billing period. Missed Payment means we did not receive the minimum monthly payment by the date of the next billing statement. Rates and criteria are subject to change. Interest is calculated daily and is charged to your account on the last day of the billing period. Interest on a purchase applies from and including the transaction date or from and including the first day of the billing period in which the purchase is first charged to your account if that date is later until the day we receive payment in FULL* However there is an interest grace period for purchases of 21 days from the Closing Date on your statement if we have received payment in FULL by the payment due date of the New Balance shown on your statement for both that billing period and the previous billing period. On a funds advance Amex cheque and balance transfer there is no interest grace period and interest is always charged from and including the transaction date until the day we receive payment in FULL* The minimum payment is i 3 of the outstanding balance as of the statement closing date or 10 or the entire new balance if it is less than 10 plus ii any previously billed minimum payments that remain unpaid on the closing date of the statement. FEES AND CHARGES Annual Fees No annual fees. Non Interest Charges Funds Advance Fee 2. 75 each Dishonoured Payment Fee 25. 00 each Statement Reprint Fee 3. 00 per statement Front Of The Line Fee 3. 50 per ticket Overlimit Fee 20. 00 will be charged at the end of a billing period if you are over your credit limit at any time during a billing period. Charges made in foreign currencies The conversion commission is 2. 5 for each charge. Except as otherwise noted these fees and commission will be charged when they are incurred and will be included on the next statement. TERMS AND CONDITIONS You ask that an American Express Credit Card Account be opened in the name of the Basic Applicant and cards Card s issued as requested and that Amex Bank of Canada we our us renew and replace them until they are cancelled* You agree to be bound by the Cardmember Agreement and disclosures Agreement received with each of the Card s and understand that if you do not wish to be bound by the Agreement the Card s must be returned* You understand that signing using or accepting Card s will constitute acceptance of the Agreement. IF YOU ARE THE BASIC APPLICANT YOU WILL BE THE BASIC CARDMEMBER AND YOU AGREE TO BE LIABLE FOR ALL CHARGES TO THE ACCOUNT WHETHER ON A BASIC OR ANY SUPPLEMENTARY CARD S. A SUPPLEMENTARY CARDMEMBER IS AN AUTHORIZED USER OF THE CARD ACCOUNT BUT IS NOT LIABLE FOR AMOUNTS OWING ON THE ACCOUNT. You certify that the information contained on this application and all future majority and are not bankrupt or insolvent or subject to any bankruptcy or insolvency proceedings. Language for Quebec residents only/aux r sidents du Qu bec seulement By completing this application in English you confirm that you wish this application the Agreement and all communications including statements notices and other documents from us our affiliates and merchants that honour the Card to be English until you otherwise advise us. En compl tant cette demande en anglais vous confirmez que vous d sirez que cette demande la convention et toutes communications y compris les relev s avis et autres documents provenant de nous de soci t s membres de notre groupe et de marchands acceptant la Carte soient r dig es en anglais sauf avis contraire de votre part. Balance Transfer The following additional terms and conditions apply to balance transfers Subject to our approval of any balance transfer the minimum balance transfer amount is 100 and the maximum is your available credit limit* You authorize and direct us to make payment of the balance transfer amount to the other card issuer on your behalf and to transfer the balance to your Card account. You will be liable to repay the balance transfer and applicable interest. Interest on balance transfers is assessed from the transaction date. Payments are applied to balance transfers before purchases but after funds advances and are first applied to balance transfers with the lowest interest rates. When you transfer and carry a balance and the new balance shown on your monthly statement is not paid in full there will no longer be an interest grace period for purchases and interest will apply to all charges at the applicable interest rate s for your account. See DISCLOSURE section for applicable interest rates. Balances must be transferred from recognized card accounts such as other financial institutions retailers and oil companies. Balances cannot be transferred to or from another account with us. You certify that the other card account is in good standing and you agree to maintain it in good standing until the balance transfer is completed* You authorize us to verify the status of the other card account. Points miles cash back and other rewards as applicable are not earned on balance transfers. Supplementary Cardmembers are not permitted to transfer balances. We reserve the right to refuse to process any balance transfer for any reason at our sole discretion including without limitation if you have missed any minimum monthly payments you have any dishonoured payments you have exceeded your credit limit the balance transfer request is not properly completed your account is not in good standing the other card is not reported on the credit bureau or we become aware of any adverse credit information* We are not responsible for any charges to or any other matters related to the other card account for example charges resulting from any delay in processing the balance transfer. Balance transfers may take 3 to 5 business days to process. PRIVACY NOTICE In this Notice the words we our and us mean Amex Bank of Canada Amex Bank its affiliates including Amex Canada Inc* a provider of travel related services and their agents and service providers acting on their behalf. Personal information is any information which relates to an individual and allows that individual to be identified Information. Consent to Use of Personal Information We collect disclose use and process Information 1 to consider initiating and to initiate maintain and develop our relationship with you in connection with our offering products and services generally including helping us to understand the current and future needs of our customers and to otherwise analyze and manage our business 2 to administer billing and accounting services and security measures in relation to your business with us 3 to monitor your transactions 4 to evaluate your credit standing 5 to share and exchange reports and Information with credit reporting agencies credit bureaus and/or any other person corporation firm or enterprise with whom you have or propose to have a financial relationship and to use other third party databases including registries and licensing authorities or references provided by you to obtain or verify Information about your financial circumstances your background or to identify you when you apply to be a Supplementary Cardmember such sharing exchange or use will be limited to obtaining or verifying Information about your background and to identify you 6 as permitted by or to comply with legal and regulatory requirements 7 to promote and to market products and services offered by us or other well established companies including by means of direct marketing through ordinary mail e-mail telephone or other available communication channels we may also send you special offers with your statements or in separate mailings that include personalized cheques to access your Card account Amex Cheque Offers and 8 where the provision of services or benefits provided to you in relation to the account are offered by or include the participation of third party suppliers to our sharing and exchanging with such third party suppliers and their agents and service providers any Information reasonably required for the provision of the service or benefit. If provided your Social Insurance Number will be used to match credit bureau/reporting agency Information to help ensure the accuracy of the Information collected and reported* If you provide an e-mail address we may also send customer service and collection notices. You agree that we may monitor and/or record any of your telephone calls with us for servicing accuracy quality assurance and training. We may use Information in our records for as long as it is needed for the purposes described above even after our relationship with you has ended* Certain consents are mandatory and cannot be withdrawn* For example once you have a card or other credit product you may not withdraw your consent relating to ongoing collection and disclosure of credit information* This is necessary to maintain the integrity of the credit granting process. You consent to our collection disclosure use and processing of Information about you for the purposes described above. You authorize third parties to give us the Information for these purposes. If you provide us with Information about any other individual you confirm that the individual i has consented to our collection disclosure use and processing of that Information for these purposes as reasonably required provided that all these purposes will apply to Supplementary Cardmembers and ii authorizes third parties to give us the Information for You may at any time refuse or withdraw your consent under 7 completely or you may select from any partial consent options we may make available by calling 1-800-869-3016. For example you may choose not to receive Amex Cheque Offers. Your request will be processed promptly but may not be captured for promotions already in progress. This will not limit information we may provide you when you contact us. Nature of Information Collected The Information we collect from time to time may include Information to identify you such as name date of birth contact information driver s license or other identification and your background for example occupation as required by law Financial Information such as income assets payment history and credit worthiness Information for the provision of products and services for example language and other preferences. We monitor transactions that may be of risk from a credit fraud or money laundering and terrorist financing perspective. Privacy Code To obtain more information about our policies and procedures in protecting your privacy you can visit our website at www. Americanexpress. ca/privacy or call us at 1-800-869-3016 to request a copy of Cardmember Agreement. Our Privacy Code includes additional illustrative descriptions and examples to help you understand the nature of the information we collect and how it relates to many of the purposes in this Notice how to request access and correction to your Information held by us and additional details about your consent rights. Disclosure terms and conditions and other information accurate as at date shown and is subject to change. For current information please call 1-800-869-3016 24 hours a day 7 days a week. Used by Amex Bank of Canada under license from American Express.