The American Express® Platinum Credit Card
OFFICE USE ONLY
Agent Name: Agent Code:
1. PLEASE COMPLETE THE FOLLOWING APPLICATION USING BLOCK LETTERS 3. PROFESSIONAL dETAILS
To ensure fast processing of your application please complete the following questions. Professional Status Employed Self Employed Retired
YES I am over 24 years of age YES I earn over $65,000 p.a. Occupation
Are you an American Express Cardmember? Present Former Never
American Express Card number: Industry
3 7 - -
Please tick if you would like to cancel your existing American Express Credit Card and
have the balance transferred to your new Card upon approval.
Unit No. Street No.
2. APPLICANT dETAILS Street name
Title Mr Mrs Miss Ms Dr
First Name Middle Initial
State Postcode business
Y Y Years
M M Mths
Driver’s Annual Salary Before Tax $ .00
Date of birth D D / M M / 19 Y Y Licence No.
If you are Self Employed please provide accountant details.
Please provide details of your Current Residential Address (PO Box not acceptable). Accountant’s Name Time with
Unit No. Street No.
Street name Accountant’s Telephone No. -
✓ I agree for my accountant to provide my details to American Express.
4. MOST FREQUENTLY USEd CARd (NOT AMERICAN EXPRESS)
Time at this address
Y Y Years
M M Months Visa MasterCard Diners Store
Residential status Own Mortgage Rent Living with Parents Current Credit Limit $ Current Outstanding $
Home Telephone No. -
Work Telephone No. - 5. 6.99% P.A. BALANCE TRANSFER RATE UNTIL THE BALANCE IS FULLY PAId OFF
Consolidate your credit cards. Simply transfer the balance from your current credit card to
Mobile Telephone No. your new Platinum Credit Card and pay it off at only 6.99% p.a. until the balance is fully paid
If you wish to receive product and service offers from us via e-mail, please provide your off – subject to our interest rate policy*.
e-mail address below.
Email address I have enclosed my current credit card statement, please transfer
Card account name
If less than 5 years at current address, please specify previous address.
Unit No. Street No.
Street name Card issuer (not American Express)
Suburb Card type: Bankcard MasterCard Visa
6. SUPPLEMENTARY dETAILS
Please send a Supplementary Card for the following person.
Name of friend or Title Mr Mrs Miss Ms Dr
relative not living with you How would you like their name to appear on their Card? (Max 20 characters).
Relationship to you
Contact Telephone No. - Relationship to Card Applicant
Office use only Date of birth D D / M M / 19 Y Y
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7. PLEASE SIGN
CP: 699Ø9 BT: F351-S By signing below, I acknowledge that I have read and agreed to the Declaration overleaf.
Basic Applicant’s Signature
✘ Date D D / M M / 200 Y
How would you like your name to appear on your Card? (Max 20 characters)
Please specify Statement cycle 0 1 2 3 4 5 6 7 8 9
statement cycle Time within the month 3 rd – 4th 6th – 7th 8th – 10th 11th – 13th 14th – 16th 17th – 18th 19th – 21st 22nd – 25th 26th – 28th 29th – 30th
IMPORTANT: THE BASIC CARD APPLICANT MUST READ THE INFORMATION AND SIGN OVERLEAF
To American Express Australia Limited (“you” or “American Express”): Transfers from an American Express Australia issued Credit Card
By signing on the previous page, I request you to issue me with the Card specified in the application, and I declare If you hold an existing American Express Australia issued Credit Card and you have requested us to close your existing
that: Credit Card account, any outstanding balances, including balance transfers on the existing Credit Card will be transferred
• The information I have given on this application is true and complete and I authorise you to check that information. to the new Credit Card. From the date of transfer, each component of these balances will attract the current interest
I acknowledge that you rely on this information to consider this application; rate for these components, except for existing balance transfers which will retain their existing balance transfer interest
• I am financially solvent and able to pay all my debts as they fall due; rate.
• If this application is approved, I will comply with the Credit Card Conditions, Financial Table and the American Balance Transfer Conditions
Express Flight Offer Conditions that you will send me with the Credit Card and will pay all fees and charges referred
to in the Financial Table; Important notes on your application
• I will comply with the Membership Rewards Terms and Conditions that you will send to me; You may make 12 balance transfers of your outstanding balances with other credit card accounts in a 12
• I understand that the I will be liable for all charges on the Basic Credit Card and all Supplementary Card(s); and month period up to 100% of the available Credit Limit (Credit Limit less previous balance less all new
• You may produce this application or a copy or other reproduction of it as evidence of my application for the Card and Charges) on your American Express Credit Card (“Credit Card”).
my agreement to this Declaration. You must continue to make payments to the designated credit card issuing companies or banks until you
• If I reside in the ACT, I will provide further financial information, if required, prior to my application being assessed. receive a statement confirming that your account has been credited. We will not be held liable for any
overdue payment or interest incurred.
I invite you and your agents and your preferred alliance organisations (including insurance companies) Payments to the credit card issuing companies or banks will normally be completed within 14 working days
to use my personal information for marketing purposes. This includes contacting me by telephone, mail from receipt of your request. We will advise you when the payment is made.
or email to discuss and agree any purchase of your products and third party products jointly marketed You will not earn Membership Rewards points on the amount transferred.
with American Express. I understand that after approval of this application, I can call 1800 059 388 if I Balance transfer promotional interest rate is only valid for the period stipulated in the offer that you have
want to withdraw this invitation and remove my name from your mailing lists. accepted. After the promotional period, you'll enjoy our prevailing annual percentage rate applicable to
Authority to American Express under the Privacy Act: you.
To assess this application, and if it is approved, to establish and manage the Card account, I understand American Restrictions on transfers
Express needs to: We reserve the right to refuse any balance transfer requests, including requests received after any
• Collect personal information about me in this application form and from other sources; and expiration date on this application form.
• Obtain my agreement in relation to the handling of my personal information. We cannot accept transfers from:
If I do not provide the information requested or give my agreement overleaf, I understand American Express may a. credit cards in foreign currencies;
decline my application. b. other American Express Cards, (except for Cards issued by independent American Express
accordance with the Privacy Act, any person may access personal information about them held by American Express, c. cards not issued in Australia;
and advise if they think it is inaccurate, incomplete or out of date. d. a card account that is in overdue or over credit limit status; and
generally about privacy matters, write to The Privacy Officer, American Express, 175 Liverpool Street, GPO Box 1582,
Sydney NSW 2001. We will not process balance transfer requests:
a. for amounts less than $100. Transfer amounts will be rounded up to the nearest dollar;
In this section, ‘personal information’ means information about me, including about my financial circumstances, my
b. if any of your Credit Card(s) is/are not in good standing or in overdue or over credit limit status;
credit worthiness, credit history, credit standing, credit capacity, my use of the Card and conduct of my account with
c. if at the time of the request you have drawn the maximum Cash Advance permitted on your Credit
I agree that, subject to the Privacy Act, you and your agents may do the following (and if this application is successful,
d. if you have already made 12 balance transfers in a 12 month period.
this agreement continues until such time as any credit provided to me is repaid):
• Obtain credit reports about me from credit reporting agencies to assess this application or to collect overdue Conditions applying once a balance is transferred
payments from me, and obtain personal information from a business that provides commercial credit worthiness We will charge interest on any balance transferred at the applicable annual percentage rate on a daily
information. basis from the date that your balance transfer request is approved until you repay the transferred amount
• Disclose personal information to credit reporting agencies before, during or providing credit to me. This includes, but in full.
is not limited to: If your Credit Card Account is not maintained in good standing at anytime, we may adjust the interest rate
- the fact that I have applied for a Card and the credit limit, and that you are a credit provider to me; applied to the balance transfer.
- advice about Card payments at least 60 days overdue and which are in collection (and advice that payments are
no longer overdue); If an increase in your current credit limit is required to complete your balance transfer, you request us to
- advice that cheque(s) drawn by me, or Direct Debit requests to my financial institution account which I have make an increase by up to 50% of your current credit limit (unless a specific increase offer is made by us).
authorised you to make, which are more than $100 have been dishonoured more than once; Any increase will be subject to a review of your Account and we reserve the right to decline your balance
- your opinion that I do not intend to meet my credit obligations or that I have committed some other serious credit transfer application should we decide not to increase your limit. Any increase will be advised in your
infringement; statement and will be rounded up to the nearest $100.
- that credit provided to me has been paid or otherwise discharged. All payments to your credit card account are applied first to transferred balances, including transferred
• Exchange personal information with credit providers named in this application or in a credit report issued by a credit balances benefiting from promotional interest rates. This will result in the balances subject to a lower
reporting agency. This is for purposes including but not limited to: interest rate being paid off first. Minimum payment requirements of the card account apply to balance
- assessing my credit worthiness, this application and any subsequent application by me for credit; transfers. There are no interest free days on balance transfers.
- notifying other credit providers of a default by me; The Terms and Conditions contained herein form part of the Credit Card Conditions governing the use of
- exchanging information about my Card account where I am in default with other credit providers; the Credit Card and shall be interpreted accordingly.
- your approval process as to any transactions I wish to make with the Card; and
- your administration of my account. Interest Rate Policy
• Exchange personal information with any person whose name I give you from time to time. This includes, * Our interest rate policy describes how we intend to adjust credit card interest rates based on your
for example, for the purpose of confirming my employment and income details with any employer, landlord/ payment history. Under this policy we intend to maintain this special low rate for the promotional period
mortgagee, accountant, financial adviser or tax agent named in this application. if you make your minimum payments on time.
• If I am in default under my 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 USA or other countries for data processing and servicing.
• Monitor and record my telephone conversations with you from time to time in order to train your staff and control
your service quality. Contact American Express for Card enquiries on 1800 657 575
• Provide personal information to any organisation whose name, logo or trademark appears on this application or on
the Card issued to me for marketing, planning, product development and research purposes, and seek from and
Monday to Friday, 8.00am-7.00pm Sydney time
exchange with such organisations personal information about me. GPO Box 1582, Sydney NSW 2001
• Provide my name and mailing address to John Fairfax Holdings Limited, Qantas and Qantas Holidays to facilitate the americanexpress.com.au
provision of the Travel + Leisure, Australia magazine and the Qantas Flight Benefit. I understand that John Fairfax
Holdings and Qantas will use this information for these purposes and that I may contact Platinum Priority Service at
1800 059 388 if I do not wish to receive these benefits.
I also agree that where I have provided you with information about another individual in this application form, I will
make sure that the individual is aware of:
- my supplying their information to you and the purposes why you have collected the information; American Express Australia Limited (ABN 92 108 952 085)
®Registered Trademark of American Express Company.
- their ability to access that information in accordance with the Privacy Act (and advise you if they think the
information is inaccurate, incomplete or out-of-date); and AE0673 04/06
- the contact details of your Privacy Officer.