The Qantas American Express Business Credit Card Form

The Qantas American Express Business Credit Card SECTION 1 BASIC CARD APPLICANT DETAILS SECTION 5 PLEASE SIGN BASIC BUSINESS CARD APPLICANT How would you like your name to appear on your new Card You can use a maximum of 20 characters including spaces Please spell your last name in full The person signing below agrees to be bound in their own right to the terms of the Declaration overleaf* maximum of 20 characters including spaces. It must be the registered business name OR the trading name OR a reasonable variation on either. Title Mrs Mr Miss Ms Surname Dr Name Date of Birth You must be over 18 years to apply D D M M Y Y Driver s Licence No* Gross Personal Income You must earn over 24 000 p*a* to apply for this Card. Have you ever been an American Express Cardmember Qantas Frequent Flyer membership number Suburb Postcode Partner Owner General Services Retail Manufacturing Automotive Construction Restaurant ABN IF TRUST LEAVE BLANK Time in Business Y Y Years M M Months Street Name State No* of Employees Registered Business Address Principal Place of Business As above Y Y Years M M Months How long have you lived at your current address If less than 5 years what was your previous address Please do not provide a PO Box No* Unit No* House No* Y Y Y Y Latest Tax Year Mobile Telephone No* No Yes I authorise my accountant to provide details to American Express Name of Accountant Accountant s Telephone No* SECTION 4 CONTACT DETAILS Business Telephone No* Estimated Monthly Business Spend Existing Merchant Relationship Latest Total Turnover SECTION 3 APPLICANT HOME DETAILS Current residential address Please do not provide a PO Box No* Other Business Entity Name IF TRUST LEAVE BLANK Never Travel and Entertainment You must be a member of the Qantas Frequent Flyer program to earn and redeem Qantas Frequent Flyer points. A joining fee applies. To apply visit qantas. com/frequentflyer Professional Services SECTION 2 QANTAS FREQUENT FLYER MEMBERSHIP SECTION 6 BUSINESS DETAILS If present or former please provide your American Express Card number. Industry/Nature of business Former Company Director Present First Name Middle Name Date Type of Business PLEASE TICK ONE Sole Trader Trust Email Address. By providing your email address you are consenting to receive changes to Terms and Conditions servicing and marketing communications via email* Complete Section 8 Company Details. Partnership Association/Co-Operative Complete Section 10 Association/Co-Operative Details. Company If you do not wish to receive marketing material via email please tick here Please tick if you would like to receive an email notification to view your statement online and not receive your statement by mail Page 1 of 4 continued over page AMXRED0126 AEX927725A 06/12 Signature of Basic Business Card Applicant SECTION 7 TRUST DETAILS SECTION 8 COMPANY DETAILS COMPLETE THIS SECTION ONLY IF THE BUSINESS IS A TRUST OR IF THE TRUSTEE OF THE TRUST IS A COMPANY An American Express representative will contact you to collect a certified copy of the Trust deed* Is the company registered by ASIC please tick one proprietary Trust Name Type of Trust e*g* Family Unit Discretionary Country where the Trust was established ABN of Trust Name of Trustee Address of Trustee Date of Birth of Trustee if individual Address Beneficiary 1 Date of Birth if applicable Full Name or Company Name of Beneficiary 2 Percentage of ownership Residential Address Beneficial Owner 2 If there are more than 4 Beneficiaries please attach on a separate page. Full Name Beneficial Owner 4 Beneficial Owners Full Name Director 5 ABN of Trustee if company or public company ACN of Company PLEASE PROCEED TO SECTION 11 AUTHORISED OFFICER OF THE BUSINESS IS THE TRUSTEE A COMPANY IF YES PLEASE ALSO COMPLETE SECTION 8 COMPANY DETAILS IF NO PLEASE PROCEED TO SECTION 11 AUTHORISED OFFICER OF THE BUSINESS SECTION 9 Partnership DETAILS SECTION 10 ASSociation/Co-Operative DETAILS Cont. Unique Identifying Number if any Full Name of Chairman Full Name of Secretary Full Name of Treasurer Full Name of the Partnership Full Name of Partner 1 Address of Partner 1 Owner if a Sole Trader Director if a Company By signing below the authorised officer binds the Business to the terms of the Declaration overleaf in his/her capacity as PLEASE TICK ONE Signature Please return the application form via Fax 02 9271 2524 OR Post Att SBS Account Manager SBS American Express Reply Paid 5148 Sydney NSW 2001. Signature of Authorised Officer of the Sole Trader Company Trust Partnership or If the Business is a Trust the Trustee agrees to be bound to the Declaration in its own right and as trustee of the Trust. Chairperson Secretary or Treasurer if an Association/Co-operative Other Please specify role Trustee if a Trust Partner if a Partnership Please ensure that the application is only sent once. Once your application has been submitted you will hear back from us within 21 working days. Office use only S/C 1XB849V001 MR Y Q1 QBREV ATI AUS32 PCT 731THG SPID 79T CO-OPERATIVE* BASIC AML If an Association an American Express representative will contact you to collect a certified copy of the constitution or rules of the association* If a Co-Operative an American Express representative will contact you to collect a certified copy of the minutes of the Co-Operative. Full Address of the Association or Co-Operative s principal place of administration or registered office Or residential address of the Association s or Co-Operative s Public Officer or President Secretary or Treasurer Please specify your preferred statement cycle Time within the month 1st 3rd 4th 6th 7th 9th 10th 12th 13th 15th 16th 19th 19th 21st 22nd 24th 25th 27th 28th 30th DECLARATION Important The Business the Basic Business Card Applicant and the Supplementary Business Card Applicant must read the information and sign overleaf* Please note that you are jointly and severally liable to American Express for the obligations incurred on each Business Card and/or Supplementary Card issued as set out above. Invitation by each Basic and Supplementary Business Credit Card Applicant to you We invite you and your agents and your preferred alliance organisations including insurance companies to use each of our personal information for marketing purposes. This includes contacting us by telephone mail or email to discuss and agree to any purchase of goods or services from an American Express company or your products and of any third party providing products jointly marketed with American Express. We understand that we can call 1300 366 220 if we want to withdraw this invitation and remove our names from your marketing lists or to cease receiving telemarketing calls. This invitation will remain in place until we withdraw it or for twelve months after we cease being an Authority to American Express under the Privacy Act 1988 Cth. To assess this application and if it is approved to establish and manage the Card account I/ we understand American Express needs to Collect personal information about me/us in this application form and from other sources and Obtain my/our agreement in relation to the handling of my/our personal information* If I/we do not provide the information requested or give my/our agreement overleaf I/we The American Express Privacy Policy Statement sets out policies on management of personal information* In accordance with the Privacy Act 1988 Cth. Any person may access personal information about them held by American Express and advise if they think it is inaccurate incomplete or out of date. To arrange access to personal information request a copy of the American Express Privacy Policy Statement or enquire generally about privacy matters write to The Privacy Officer me/us. This includes but is not limited to he fact that I/we have applied for a Card and the credit limit and that you are a credit t provider to me/us advice about Card payments at least 60 days overdue and which are in collection and advice that payments are no longer overdue advice that cheque s drawn by me/us or Direct Debit requests to my/our financial institution account which I/we have authorised you to make which are more than 100 have been dishonoured more than once your opinion that I/we do not intend to meet my/our credit obligations or that I/we have committed some other serious credit infringement that credit provided to me/us has been paid or otherwise discharged and any other use in conjunction with my account as permitted under the Privacy Act. Exchange personal information about you including information from credit reports with any person considering whether to act as a guarantor in relation to this and future applications by you for credit. Report issued by a credit reporting agency. This is for purposes including but not limited to assessing my/our creditworthiness this application and any subsequent application by me/us notifying other credit providers of a default by me/us xchanging information about my/our Card account where I/we am/are in default with e other credit providers your approval process as to any transactions I/we wish to make with the Card and your administration of my/our account. Time. This includes for example for the purpose of confirming my/our employment and income details with any employer landlord/mortgagee accountant financial adviser or tax agent named in this application* If I/we am in default under my/our Card account notify and exchange personal information with your collection agent. Transfer personal information confidentially to your related companies and other organisations which issue or service American Express Cards or provide services to you subject to appropriate conditions of confidentiality. This includes transferring personal information to the USA or other countries for data processing and servicing. Monitor and record my/our telephone conversations with you from time to time in order to train your staff and control your service quality. Provide personal information to any organisation whose name logo or trademark appears on this application or on the Card issued to me/us for marketing planning product development and research purposes and seek from and exchange with such organisations personal I/We also agree that where I/we have provided you with information about another individual in this application form I/we will make sure that the individual has seen understood and agreed to my/our supplying their personal information to you and the purposes for which you have collected the information their ability to access that information in accordance with the Privacy Act 1988 Cth. And advise you if they think the information is inaccurate incomplete or out of date and the contact details of your Privacy Officer. Business Purpose Declaration I/We declare that the credit to be provided to me/us by the credit provider is to be applied wholly or predominantly for business or investment purposes or for both purposes. Important You should NOT sign this declaration unless this loan is wholly or predominantly for business or investment purposes. By signing this declaration you may lose your protection under the Consumer Credit Code. In this section personal information means information about me/us including about my/our financial circumstances my/our creditworthiness credit history credit standing credit capacity my/our use of the Card and conduct of my/our account with you. I/We agree that subject to the Privacy Act 1988 Cth. you and your agents may do the following and if this application is successful this agreement continues until such time as any credit provided to me/us is repaid Obtain credit reports about me/us from credit reporting agencies to assess this application or to collect overdue payments from me/us and obtain personal information from a business that provides commercial creditworthiness information* Disclose personal information to credit reporting agencies before during or providing credit to Please allow up to 21 working days for application processing* Contact American Express for Card enquiries on 1300 366 220 8am 7pm Sydney time 7 days. GPO Box 1582 Sydney NSW 2001 americanexpress. com*au Registered Trademark of American Express Company. By signing on the previous page the Business the Basic Business Credit Card Applicant and the Supplementary Business Card Applicant together we us or our request you to issue Business Credit Cards to each Basic Business Credit Card Applicant and Supplementary Business Credit Card Applicant specified in the application and we each declare and undertake to you that The information given on the application is true and complete. We authorise you to check that information and authorise our accountants to provide and verify to you any further details requested concerning the information* We acknowledge that you rely on all such information and further details to consider the application Each of us is financially solvent and able to pay our respective debts when due If the application is approved we will comply with the Business Credit Card Conditions that you will send to the Basic Business Credit Card Applicant with their Card receipt of which will be taken to constitute receipt also by the Business and to the Supplementary Business Credit Card Applicant and we will jointly and severally be liable to pay all fees charges and other amounts under the Business Credit Card Conditions and this Declaration Membership Rewards will comply with the Membership Rewards Terms and Conditions that If a trustee of a trust has signed this application then the trustee agrees to be bound in its own right and as a trustee of the trust We understand that the Business and the Basic Business Credit Card Applicant will be jointly and severally liable for all charges incurred with each Basic Business Credit Card be the responsibility of the Business the Basic Business Credit Card Applicant and the the account of the Business and the Business Credit Card Applicant You may produce this application or a copy or other reproduction of it as evidence of our application for the Card and our agreement to this Declaration and If I reside in the ACT I will provide further financial information if required prior to my application being assessed*.