Cs Colorband 285 American Express Corporate Services Form

CORPORATE EXPENSE MANAGEMENT SOLUTIONS The American Express Gold Corporate Card Application Form The Applicant aged 18 years and over and the Company join in this application for the issue of a Corporate Card to the Applicant including any renewal and replacement Cards and agree to be jointly and severally liable for all charges on the Card issued to the Applicant pursuant to paragraph 4b of the Cardmember Agreement Terms and Conditions. A Cardmember Agreement will accompany the Card when issued* American Express may decline this application in its sole discretion* Before signing this application it is important that you read the paragraphs entitled Use of Personal Information of the Terms and Conditions which set out how we collect and use information about you for the purpose of providing you with the Corporate Card service. By signing this application you agree that we can use your information in this way. By signing this application you agree that for the purpose of processing it American Express a may make searches about you at credit reference agencies including agencies conducting the information system on persons with outstanding credits or other payment obligations c will verify your identity pursuant to Act No* 61/1996 Coll* on selected measures against legitimization of proceeds of crime. Your Business Details Company Registered Name Postcode City Registration Number Telephone Number Your Workplace Address if different from company address Your Personal Details Mr Ms Title s Name s Surname Date of Birth Name on Card Please insert your name in the space above as you wish it to appear on the Card using no more than 25 letters or spaces Permanent Address Street number Current address If different from permanent address Work Tel* Number Mobile Tel* Number Home Tel* Number Current Monthly Income CZK Mother s Maiden Surname Password E-mail Address Date joined Company Position held in Company Billing Address Employee No* Workplace Department Code Any previous or current American Express cards No Yes For individually billed accounts please indicate method of payment Bank Transfer For payment by Direct Debit please state Bank Account Number Card Number Direct Debit Bank Code and I confirm that I have read and agree to all the Terms and Conditions of Corporate Cardmember Agreement. Signature and date To be completed by your company It is essential that this form is counter-signed by an authorised signatory signing for and on behalf of the Company making the application* Work Telephone Number Please insert here the Company number under which this application should be processed confirm that for the purpose of issuing American Express Corporate Card we have verified the name surname date of birth address and consent of employee s appearance with the image on the identity card of above stated employee according to valid identity card with its copy attached to the application* At the same time we authorize American Express to issue the Card for this employee. EMPLOYEES I MAXIMISE CONTROL I DRIVE SAVINGS I BENEFIT EMPLOYEES I MAXIMISE CONTROL I DRIVE SAVINGS I BENEFIT EMPLOYEES I REAL BUSINESS* REAL SOLUTIONS*SM Please complete and return the form American Express spol* s r. O. Na P kop 19 117 19 Prague 1 Czech Republic telephone 420 222 800 333 Gold Corporate Cardmember Agreement Terms and Conditions The Czech National Bank issued Sample Business Conditions for issuance and use of electronic means of payment with effect from January 1 2003 the full wording of the Sample Business Conditions is published at the address www. Cnb. cz. These General Contractual Conditions differ from Article VI Paragraph 1a d of the Czech National Bank s Sample Business Conditions. American Express Services Europe Limited does not automatically assume responsibility for failure to perform or wrong performance of the Cardmember s transactions. Cardmembers claims will be considered individually and the Cardmember will be informed of the investigation findings. Please read this Agreement very carefully. 1. Acceptance of the Card a You must sign the Card before you start to use the American Express Corporate Card. B You and your Company formally agree to the terms of this Agreement. The issuance of the Card and the acceptance and use of it will be governed by this Agreement. C This Agreement binds both you and your Company to payment of Charges as set out in paragraph 4 a. D You must use the Card only during the validity period embossed on the front of it. 2. Definitions a Throughout this Agreement the word Card means the American Express Corporate Card issued to you on a Corporate Card Account for the purpose of purchasing goods and/or services on behalf of your Company unless your Company has consented otherwise. B The Card specially issued in case of loss theft damage and non-arrival is referred to as the Replacement Card. C The words you and your means the Cardmember that is the person named on the Card issued* The words we our and us refer to American Express Services Europe Limited AESEL Belgrave House 76 Buckingham Palace Road London SW1W 9AX its successors and assignees. The Corporate Card Account holder referred to as your Company is the company business or firm in whose name an account is held with us and who has authorized the issue of the Card to you. D The word Charges means all amounts incurred by the use of the Card all Card fees contractual penalties for late payment referred to in paragraph 6 d and any other fees and costs under this Agreement. Charges not specified in these Contractual Conditions are negotiated individually. e Firms and organizations accepting the American Express Card for the payment of goods or services are referred to as Service Establishments. And us. 3. Card Use a You are the only person who may use the Card bearing your name for Charges. The Card is issued to you solely for the purchase of goods and services on behalf of your Company unless your Company has consented otherwise. B You may be able to enroll in the Corporate Express Cash program to obtain cash at ATM dispensing machines. We will have a separate agreement with you concerning use of the Corporate Card in connection with the program* This program may not be available in every jurisdiction* c The cash withdrawal limit is CZK 30 000 during any period of seven consecutive days unless it is negotiated individually and subject to compliance with payment conditions contained in Article 6. The limit for payments for goods and/or services is not set in advance unless it is negotiated individually and subject to compliance with payment conditions contained in Article 6. You are obligated to take all steps to prevent theft loss and misuse of the Card by unauthorized persons. If a Personal Identification Number PIN is activated for the Card prevent its disclosure. PIN recorded anywhere shall not be identifiable as such and shall be kept separately from the Card. D You undertake not to re-sell or return for cash refund any goods tickets or services obtained with the Card but goods or tickets may be returned to a Service Establishment for credit to your Card account if the Service Establishment permits such returns. E If you use the Card to buy insurance you authorize us to pay premiums on your behalf and you undertake to repay us accordingly. You must tell us in writing if you wish us to stop* Any refunded premiums must be treated as returns in accordance with paragraph 3 d. F We may in our absolute discretion and without prior notice refuse any request for authorization of any particular Charge or Charges. 4. Billing a Whenever there is a balance due on your Card account a monthly statement is sent to you or your Company. The printed statement could be replaced by the statement in electronic form if agreed by parties Card issued to you whether or not a Record of Charge form is signed by you with the following exceptions for which you are solely liable i Charges incurred on behalf of the Company for which you have been reimbursed by your Company cancellation or withdrawal of the Card from the next working day after the date when we receive the notification from your Company of such termination cancellation or withdrawal iii Charges arising from your act of dishonesty c You must tell us immediately of any change in your billing address. D All annual or other fees associated with your Card membership are not refundable. 5. Foreign Currency Charges If a Charge is made in a currency other than Czech Koruna CZK that Charge will be converted into Czech Koruna CZK. The conversion will take place on the date the Charge is processed depends on when the Charge was submitted to American Express. If the Charge is not in U*S* dollars the conversion will be made through U*S* dollars by converting the Charge amount into U*S* dollars and then by converting the U*S* dollar amount into Czech Koruna CZK. If the Charge is in U*S* dollars it will be converted directly into Czech Koruna CZK. Unless a specific rate is required by applicable law you understand and agree that the selects from customary industry sources on the business day prior to the processing date increased by a single conversion commission of 2. If Charges are converted by third parties prior to being submitted to American Express any conversions made by those third parties will be at rates selected by them* 6. Payment a All Charges are due for payment in full in Czech Koruna immediately upon receipt of the monthly statement. B The account must be settled in Czech Koruna* Any payment made in any other currency if accepted by us is converted into Czech Koruna* This will delay the credit to your Card account and may involve the charging of conversion costs. C We may at our discretion accept late or partial payment described as being payment in full or payment in settlement of a dispute but in so doing we do not lose or consent to vary any of our rights under this Agreement or under the law. In the event that late or partial payment is accepted for monthly statements sent to and due and payable from the Company then contractual penalties for late payment as provided for in d below shall not be your responsibility provided the unpaid Charges do not come within section 4b i - iv inclusive above. D We may charge you or your Company contractual penalties for late payment of the overdue balance monthly in arrears at the following rates i at 21 days after statement date 3. 0 of all outstanding sums with a minimum charge of CZK600 and ii at 42 days after statement date 3. 0 of all outstanding sums excluding any unpaid CZK600 and iii when a Card account is referred to collection which may be a firm of lawyers an appropriate file referral charge will be added to the then outstanding sum* e The day of payment is the day on which the payment is credited to your Card account. We are not responsible for delay caused by bank-to-bank clearing. f If your Card is 60 days overdue for payment your Card will be suspended and may be cancelled* In the event of cancellation a charge of CZK 5 200 will be applied to have the Card reinstated* Reinstatement shall be at our sole discretion* cheque sent to us by you or on your behalf any direct debit which is not honored in its full amount and in respect of any reference of your account to a third party collector. Covered by this Agreement. 7. Claims / Queries a If you or your Company have any queries about the monthly statement you or your Company must tell us immediately but not later than within 75 days of the statement date. We will inform you of the result of the claim investigation within 60 days of the filing of the claim* b Unless required by law we are not responsible for goods or services charged to the Card. In all circumstances the full amount shown on the monthly statement must be paid* Any dispute should be settled directly with the Service Establishment concerned* Once you have properly incurred a Charge on your Card we are obliged to pay the Service Establishment. The Charge can only be subsequently cancelled or withdrawn with the agreement of the Service Establishment. C We accept no responsibility for the failure of a Service Establishment to accept the Card or for any loss or damage arising from the manner of its acceptance or non-acceptance of the Card. 8. Dispensing Machines services we accept no responsibility for any damage or loss that you or your Company may suffer but we will repay any amount incorrectly debited to your Card account. If you enrol in the Express Cash Service your use of this facility will be governed by a separate agreement but at all times you and your Company shall be jointly and severally liable for all transactions and charges in connection with such use. 9. Lost Cards a You must notify us immediately if the Card is lost stolen damaged or not received when due and you must notify us if you suspect that the Card is being used without your authority. B You are liable for any unauthorized use of your Card to the extent permitted by law. c However once you or your Company have notified us orally or in writing of its loss non-arrival or misuse your liability is limited to a maximum CZK 1200 up to the moment of reporting provided that you have acted in good faith and without negligence and the Card has not been used by a person who acquired possession of it with your consent. After we have been effectively notified your liability for any subsequent use of the Card other than by you or with your authority will cease. D If you subsequently retrieve the Card reported missing you must not use it. The retrieval of the original Card must be reported to us immediately and the Card cut in two. Do not return it to us. e You must give us all the information in your possession as to the circumstances of the loss theft or misuse of your Card and we may disclose as we deem necessary any information we consider relevant to any investigation* 10. Renewal a We will renew the Card or Replacement Card before the expiry of the current Card. We bill card fees annually. B We will continue to renew the Card in this way until you or your Company ask us to stop* 11. Card Cancellation a The Card remains our property and you must return it to us on demand. Where we have reasonable grounds we may revoke your right to use the Card entirely or in respect of a particular transaction at anytime in our absolute discretion without giving you prior notice. This could be especially to prevent fraud or because we think you and your Company may not be able to pay the monthly statement in full on time. If we do this we will tell you and the Company immediately afterwards. We may terminate from notice. This Agreement shall terminate by the delivery of the notice. This Agreement shall be automatically terminated in case of termination of the Corporate Card Account Agreement. B We may list cancelled Cards in our Cancellation Bulletin or otherwise inform Service Establishments of such cancellations. If a Service Establishment at our request asks you to surrender the Card you must do so. c The Card may be cancelled at the request of either you or your Company. D You must not use the Card after cancellation or expiry. We will charge to your Card account any Charges arising from the use of the Card by you or with your authority after e We may cancel the Card issued to you where you have not used it for a period of at least 12 months. If we do so we will notify you at least 30 days prior to cancellation* 12. Change of Agreement Assignment We have the right to change this Agreement at any time. We will notify you of any changes before they become effective. We will consider that you have accepted the changes if you keep or use the Card after you receive our notice. If you do not accept the changes you may terminate this Agreement by giving us written notice. You will still be responsible for all Charges made before you terminated the Agreement. We may assign this Agreement at any time without notice. 13. Use of Personal Information analyzing and collecting Charges on the account and managing the benefits insurance travel or other corporate programmes in which you are and/or your Company is enrolled exchange information about you and your Card account which may include details of goods and/or services purchased with - companies within the American Express group of companies worldwide - our processors and suppliers - organizations which accept the Card in payment for goods and/or services purchased by you - any party whose name or logo appears on your Card and their processors and - any person or entity authorized by you. Where you purchase goods and/or services on behalf of a third party you confirm that you have obtained the consent of that third party to the disclosure of his or her information to ii unless you ask us not to use information about you and how you use your Card and programmes in which you are enrolled to develop reports and lists for use within the issue the Card and other companies approved by us in order that we or these companies may improve or enhance products and services offered to you or your employer and/or develop or make offers by mail e-mail or telephone to you and/or your employer of products and services in which you or your employer may be interested* The information used to develop these reports and lists may be obtained from your Card application from information on where and how you use the Card Registered Office Belgrave House 76 Buckingham Palace Road London SW1W 9AX Great Britain Registered number 1833139 www. Americanexpress. cz CAM 3804 01/07 from surveys and research which may involve contacting you by mail e-mail or telephone and information obtained from other external sources such as merchants marketing organizations and computerized reservation systems. If you prefer not to receive offers of relevant products and/or services please write to American Express spol* s r. O. Na P kop 19 117 19 Praha 1 providing your full name and Corporate Card number and this will be forwarded to AESEL iii exchange information about you including your personal data especially name surname date of birth and address and how you conduct your Card account with credit reference agencies chosen by AESEL including the agencies which conduct the information system on persons with outstanding credits or other payment obligations hereinafter the information system in the event that you have been reimbursed by your employer for valid Charges on your account have not disputed such Charges with us and have failed to pay us for them without reason upon receiving notice from us of the amount due. You agree that this information may be shared by AESEL with other organizations entities that are authorized to receive this information from the system* It applies on all information in assessing applications for credit or other facilities from you and members of your household for occasional debt tracing and fraud prevention iv carry out credit checks with credit reference agencies including agencies who conduct the system as set out in iii above whilst any money is owed by you on your Card account in the circumstances set out in iii above including contacting your employer bank or building society or any other referee approved by you and exchange information about you and your Card account with your employer collection agencies authorized entities in the system chosen by AESEL and lawyers for the purpose of collecting debts on your Card account v carry out further credit checks with credit reference agencies including agencies conducting the system as set out in iii above and analyze information about you and charges on your Card account to assist us in managing your account authorizing Charges on it and to prevent fraud vi You agree that AESEL is entitled to share the information with credit reference agencies who conduct the system in the cases set up in iii iv and v during the validity of the contractual relation between you and AESEL and 3 years after its termination* You will be informed on the authorized receivers of your data from the system chosen by AESEL on your written request. Vii monitor and/or record your telephone calls to us or ours to you either ourselves or by reputable organizations selected by us to ensure consistent servicing levels including staff training and where permitted by law to assist in dispute resolution and viii undertake all of the above both within and outside the Czech Republic* This includes processing your information in the USA in which data protection laws are not as comprehensive as in the Czech Republic* When you travel or make foreign purchases by mail e-mail or telephone American Express may also disclose your information to or access it in other countries outside the Czech Republic in which data protection laws may not be as comprehensive as in the Czech Republic* In this case American Express has taken appropriate steps to ensure the same level of protection for your information in the USA and other countries as there is in the Czech Republic* b We use advanced technology and well-defined employee practices to help ensure that your information is processed promptly accurately and completely. If you ask in writing we will tell you in writing without undue delay what information we hold about you and provide it to you in accordance with applicable law. There may be a charge for this as permitted by law. If you believe that any information we hold about you is incorrect or incomplete you should write without delay to American Express spol* s r. O. Na P kop 19 117 19 Praha 1 and this will be forwarded to AESEL* Any information which is found to be incorrect or incomplete will be corrected promptly. You grant hereby in accordance with the Law No* 101/2000 Col* on personal data protection the approval to us and to the company American Express spol* s r. O. Na P kop 19 117 19 Praha 1 to the processing and using your personal data which you provided for the purpose of the fulfillment of the subject of the Corporate Cardmember Agreement. You grant this approval for the whole duration of the Agreement and for subsequent ten years after its 14. Exchange Control which may be issued from time to time. 15. Applicable Law the laws of the Czech Republic* b Any disputes arising from this Agreement or in relation with this Agreement shall be submitted to the Arbitration Court attached to the Economic Chamber of the Czech Republic and Agricultural Chamber of the Czech Republic hereinafter the Arbitration Court. The contracting parties agree that the dispute shall be resolved according to legal regulations of the Arbitration Court by one arbitrator and the parties empower the Chairman of the Arbitration Court to nominate the arbitrator. Further on parties agree that the arbitrator may decide the dispute without oral proceedings based on the writings only. C You agree however that we may conduct collection proceedings in any jurisdiction in which you may be resident from time to time.