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									 THIS IS A FILLABLE PDF FORM. CLICK IN THE FIRST FIELD TO START & USE THE TAB KEY TO MOVE FROM FIELD TO FIELD        PRINT   CLEAR




                CORPORATE SERVICES
                EXPENSE MANAGEMENT SOLUTIONS




                American Express®

                Corporate Account Agreement and Set-Up
               American Express          ®

                Sole Liability
                Australia




S | BENEFIT EMPLOYEES | MANAGE GLOBALLY | MAXIMISE CONTROL | DRIVE SAVINGS | BENEFIT EMPLOYEES | MANAGE GLOBALLY |
PLEASE COMPLETE THE FOLLOWING FORM IN CONJUNCTION WITH YOUR AMERICAN EXPRESS REPRESENTATIVE. SIGN IT AND RETURN IT TO YOUR AMERICAN EXPRESS REPRESENTATIVE.
All fields are MANDATORY and must be completed in black pen and block letters.


    1. CORPORATE CARD ACCOUNT AGREEMENT AND SET-UP                                                                        1. CORPORATE CARD ACCOUNT AGREEMENT AND SET-UP (CONTINUED)

  Corporate Details                                                                                                     If Partnership the full name and address of all Partners (If more, please provide as separate document)
    Company Name (in full)                                                                                                  1. First Name                                        Last Name
    (As per registered ABN Company Name)
                                                                                                                          Full Residential Address

  Company Name to appear on Corporate Card (maximum 24 characters)
                                                                                                                                                                            State                 Postcode
                                                                                                                          Email Address
     Registered Address
                                                                                                                          Date of Birth (one Partner only required)

                                                                                                                          2. First Name                                          Last Name
     Principal Place of Business
     (if different from above)                                                                                            Full Residential Address
     Mailing Address
     (if different from Company Address)
                                                                                                                                                                            State                 Postcode
                                                                                                                          Email Address
                                                                Country
                                                                                                                          3. First Name                                          Last Name
  State                    Postcode

  Telephone Number                         –                                                                              Full Residential Address

  Fax Number                               –
                                                                                                                                                                            State                 Postcode
  Company Type               Proprietary            Public                                                                Email Address
     Industry or Nature
     of Business
     Annual Revenue/Turnover
                                                                                                                          2. ACCOUNT SET-UP DETAILS
     Year Company Formed                                      Number of Employees
                                                                                                                          Potential Number of
                                                                                                                          Corporate Cardmembers

  Business Registration No.: ABN
                                                                                                                        Billing Method1:                               Cardmember
      ARBN/ACN/CO-OP/ASSOC ID
                                                                                                                        Payment Options2:                              Company                           Cardmember
     Country/State/Territory
     of establishment/incorporation
                                                                                                                        Payment Method:                                Company Direct Debit              Cheque
  What type of entity is your Corporation? (Tick all that apply)
       Australian                 Registered                     Unregistered
                                  Foreign Company                Foreign Company                                              Electronic Funds Transfer                Individual Direct Debit           BPay
       Company
       Incorporated               Unincorporated
                                                                 Cooperative*                                                 Individual pay online
       Association*               Association*
                                                                 Trust* – please circle trust type:                     How is the annual Card Fee Billed?3:
       Partnership*               Government Body
                                                                 Family / Unit / Discretionary
   Other                                                                                                                      Centrally to a separate cost centre               To appear on Cardmember’s statement
                                                                                                                        If annual Card fees are requested to be billed centrally, please complete Recipient details:
  If Australian Proprietary Company, list name(s) of Director(s): (If more, please provide as
                                                                                                                           Recipient Name
  separate document)                                                                                                       and Position4
                                                                                                                          Recipient Address
     1.

     2.
                                                                                                                        (If different from street address above. Must be street address)
     3.
                                                                                                                          Date Statements
                                                                                                                          Required5
     4.
                                                                                                                          When does the Company’s
  If a Registered Foreign Company, state the country in which the Company, Trust or Partnership                           Financial Year Start?
  was formed, registered or incorporated and list name(s) of Director(s): (If more, please provide
  as separate document)                                                                                                 Common Anniversary Date6:                Yes, if so, which Month
                                                                                                                        (for Card Fees)
     Country
                                                                                                                        Card Distribution7:          Centrally        To Cardmember’s Billing Address
     1.
                                                                                                                        If central Card distribution is requested, please complete Recipient details:
                                                                                                                           Recipient Name
     2.                                                                                                                    and Position8
                                                                                                                          Recipient Address
     3.
  If Unregistered Foreign Company, state the full address of principal place of business in it’s
  Country of formation or incorporation:
                                                                                                                        (If different from street address above. Must be street address)




     Province/State                                           Zip/Postcode

     Country




* Note: For non-company entities, please provide establishing documents (eg. Trust deeds, partnership agreement etc).



                                                                                                                                                                                                                         P2 of 6
  3. CONTACT DETAILS                                                                                                  5. NOTES (CONTINUED)
Authorising Signatory9 (for future application authorisation)                                                    5. Approximately, on what date each month do you wish to receive your Corporate Card
   Name                                                                                                              statements?
                                                                                                                 6. Do you want all Card fees for the Company to be billed on the same month, if so, when?
   Title                                                                                                         7. Do you want the Corporate Card to be mailed to each Cardmember or sent to a central
                                                                                                                     contact in the Company for onward distribution?
                                                                                                                 8. Only applicable where central Card distribution is requested.
Telephone Number                       –                                                                         9. Who is the Company’s Authorising Officer?
Fax Number                             –                                                                         10. Who is the key Company contact for the American Express Corporate Card to receive the
                                                                                                                     Company reports?
   Email Address*


                                                                                                                      6. VERIFYING YOUR IDENTITY
  Signature
                                                                                                                 American Express needs to verify your identity to comply with the Anti-Money Laundering and
   ✘                                                                          Date    D D   /   M M   /   YYYY
                                                                                                                 Counter-Terrorism Financing Act 2006. We will attempt to electronically verify your identity based on the
                                                                                                                 details in your application and available electronic registers. However, if this is unsuccessful, you agree
Additional Authorised Officer                                                                                    that you will provide us with satisfactory documentary evidence to allow us to verify your identity.
  Name

   Title                                                                                                              7. AMERICAN EXPRESS CORPORATE ACCOUNT AGREEMENT – FULL CORPORATE (SOLE) LIABILITY

                                                                                                                 1.     Definitions
Telephone Number                       –                                                                                Within this agreement, please remember that the expressions ‘we’, ‘our’, ‘us’ means
                                                                                                                        American Express Australia Limited (ABN 92 108 952 085). The expressions ‘you’,
Fax Number                             –                                                                                ‘your’ means the Company applying for the Account. ‘Account’ or ‘Accounts’ mean
   Email Address*                                                                                                       your American Express Corporate Card account. ‘Corporate Card’ and ‘Card’ means
                                                                                                                        an American Express Corporate Card issued on your Account. ‘Company’ means the
                                                                                                                        company, firm or organisation whose name appears on this Corporate Card Account
                                                                                                                        Agreement and Set-Up Form. ‘Corporate Cardmember’ and ‘Cardmember’ means an
  Signature                                                                                                             individual to whom a Corporate Card is issued at your request. ‘Charges’ means all
                                                                                                                        amounts charged to an Account, regardless of whether a charge form or other charge
   ✘                                                                          Date    D D   /   M M   /   YYYY          authorisation is signed, including purchases of goods and services, cash advances,
                                                                                                                        late payment fees or liquidated damages and any other fees or charges. ‘Cardmember
Report Recipient 10 (Program Administrator)                                                                             Agreement’ means the agreement between us and the Cardmember governing use of a
  Name                                                                                                                  Card and liability for charges.
                                                                                                                 2.     Scope of this Agreement
   Title                                                                                                                This Agreement sets out the basis on which we shall provide you with the Account.
                                                                                                                 3.     Accounts and Cards
                                                                                                                        We will issue Corporate Cards on your Account bearing your name and those of your
Telephone Number                       –                                                                                designated employees.
                                                                                                                 3.1    We reserve the right to:
Fax Number                             –                                                                                a) require each prospective Corporate Cardmember to complete our application for the Card;
   Email Address*                                                                                                       b) carry out credit checks on you and/or Corporate Cardmembers, subject to applicable legal
                                                                                                                             requirements. This includes, but is not limited to, obtaining credit reports from credit
                                                                                                                             reporting agencies;
                                                                                                                        c) decline to issue, renew or replace a Card to any person;
Additional Contact (See above)                                                                                          d) cancel or suspend the use of a Card at any time either generally or in relation to a
  Name                                                                                                                       particular transaction.
                                                                                                                 3.2    We shall renew and replace Cards, subject to 3.1 above, until you or the Cardmember
   Title                                                                                                                directs otherwise.
                                                                                                                 4.     Your Liability For Charges – Sole Liability
                                                                                                                        You are liable for all Charges on the Corporate Cards.
Telephone Number                       –                                                                         4.1    You are not liable for unauthorised charges on the Account, which means Charges that did
                                                                                                                        not benefit either you or the Corporate Cardmember and which were incurred by someone
Fax Number                             –                                                                                who was not the Cardmember and who had no actual, implied, or apparent authority to
   Email Address*                                                                                                       use the Card.
                                                                                                                 4.2    You must notify us as soon as you become aware or have reason to suspect that a Card is
                                                                                                                        lost or stolen or if a Card or your Account is at risk of being misused.
                                                                                                                 4.3    You agree to provide us with reasonable assistance to collect overdue amounts from
* If you wish to receive important information about your account, product offers and service updates from
                                                                                                                        Corporate Cardmembers, including but not limited to details of the Cardmember’s last
  us via email please provide your email address.
                                                                                                                        known address and telephone number, use of the Card or Account by the Cardmember
                                                                                                                        and reimbursement by you of Charges incurred by the Cardmember.
                                                                                                                 4.4    You must notify us immediately if a Corporate Cardmember’s authority to incur Charges
  4. AMERICAN EXPRESS OFFICE USE ONLY                                                                                   terminates (due to termination of employment or any other reason). You remain solely
                                                                                                                        liable to pay us for all Charges incurred until we receive notice of such termination
                                     Sales Database ID                                                                  from you.
Sales Code                                                                                                       4.5    You will use your best efforts to collect and destroy Cards issued to individuals whose
                                                                (Mandatory requirements for all leads                   authority to incur Charges is terminated, who leave your employment for any reason or
Deal Code                                                       from QBT and their subsequent expansions)               whose Cards have been cancelled.
  Sales Person Name                                                                                              5.     Financial Provisions/Service Fees
                                                                                                                        The following fees apply to this Account:
                                                                                                                 	         A
                                                                                                                        •	 	 	card	reinstatement	fee	of	AUD$35	is	payable	if	your	Card	has	been	suspended	or	
Sales Person Phone                     –                                                                                   cancelled and we agree to reinstate it.
  Sales Person Email                                                                                             6.     Use of the Card
                                                                                                                        You may only use the Card in accordance with these Conditions within the validity dates
                                                                                                                        shown on its face. You must not give the Card or your account number to others or allow
  Number of applications submitted
                                                                                                                        them to use it for charges, identification or any other purpose. If you do so, you will
                                                                                                                        be liable for all charges incurred on the Card as a result. You must not use the Card to
  Date sent                                              Date received                                                  purchase anything for the purpose of resale unless permitted by us in writing. You must
                                                                                                                        not return any goods, tickets or services obtained with the Card for a cash refund, but
                                                                                                                        you may return them to a merchant for credit to the Card account, if that merchant agrees
                                                                                                                        or is obliged to do so. You shall not obtain a credit to the account for any reason other
  5. NOTES                                                                                                              than as a refund for goods or services previously purchased with the Card. You must not
                                                                                                                        use the Card if a petition for winding-up of the Company is issued (unless the petition
1. Cardmember to receive the monthly Corporate Card statement.                                                          is no longer in force), or if the Company passes a resolution for its liquidation or has a
2. Who will be paying the monthly Corporate Card statement? Whoever receives the monthly                                receiver appointed over any of its assets. You must not use the Card if you do not honestly
   statement will be contacted if the Corporate Card account comes overdue. Choose one                                  expect to be able to pay your account in full on receipt of your monthly statement. You
   option only.                                                                                                         acknowledge and agree that we have the right to refuse authorisation for any charge
3. Do you wish the annual Card fee billed centrally, to a separate cost centre or individually, on                      without cause or prior notice, and that we shall not be liable to you or anyone else for
   the Cardmember statement?                                                                                            any loss or damage resulting in such refusal. You may not use the Card for any unlawful
4. Only applicable where annual Card fees are requested to be billed centrally.                                         purpose, including the purchase of goods or services prohibited by the laws of Australia or
                                                                                                                        any country where the Card is used or where goods or services are provided.


                                                                                                                                                                                                                    P3 of 6
     7. AMERICAN EXPRESS CORPORATE ACCOUNT AGREEMENT – FULL CORPORATE (SOLE) LIABILITY                         7. AMERICAN EXPRESS CORPORATE ACCOUNT AGREEMENT – FULL CORPORATE (SOLE) LIABILITY
7.     Payment of Charges                                                                                    14.2 If we agree to place any limits or restrictions on the type of Charges incurred on any Card or
7.1    You agree to pay all Charges shown on each monthly Account statement on receipt. We                        Account, we are obliged only to use reasonable efforts to apply such limits or restrictions and
       will send you statements for each Account in paper format, unless we agree with you to                     this does not affect your liability for any Charges. We are unable to block or prevent Charges
       provide Cardmembers with electronic statements.                                                            at certain merchants, including but not limited to merchants who do not process Charges via
7.2    You agree not to deduct or withhold, without our prior approval, any amount shown as                       electronic terminals or who have provided us with a description of their own activities which
       due on any Account statement. If you or the Cardmember believe any Charge shown on                         may be incomplete or inaccurate. In classifying merchants in our system or records, we are
       a statement is in error or in dispute with the merchant or seller, you may request, and we                 entitled to rely on any description of their own activities provided by such merchants.
       may set up and maintain for a reasonable period, a temporary credit on the Account for                15. Indemnity
       the disputed portion of the Charge while we investigate the error or you seek to resolve              15.1 Each party agrees to indemnify the other against any claims, liabilities, losses or damages
       the dispute.                                                                                               (including reasonable legal fees) incurred by the other party arising out of the indemnifying
7.3    Acceptance of late payments, partial payments or any payment marked as being payment in                    party’s failure to perform, or its negligent or wrongful performance of this Agreement.
       full or as being a settlement of a dispute will not affect any of our rights to payment in full.      15.2 Neither party shall be liable to the other party or any third party for any special, incidental,
8.     Privacy                                                                                                    indirect, consequential or punitive damages.
8.1    You agree that we may collect, use and transfer personal information about Corporate                  15.3 Each party agrees to notify the other without delay of any circumstances in respect of
       Cardmembers in accordance with the authorisation set out in our Cardmember Application                     which it claims indemnification under this section and to allow the other to have control of
       Form under ‘Authority under the Privacy Act’.                                                              any related negotiations or proceedings.
8.2    You agree that we may conduct customer research, and monitor and record telephone                     16. Confidentiality
       conversations with you or your staff from time to time for training, quality control or               16.1 Each party agrees to treat the terms of this Agreement as strictly confidential, as well as all
       verification purposes.                                                                                     information received from the other party which is not publicly available.
8.3    You also agree that where you have provided us with information about individuals in this             16.2 This provision shall survive the termination of this Agreement.
       Account request form, you will make sure that those individuals are aware of:                         17. Term and Termination
	      •		 ou	supplying	their	information	to	us	in	connection	with	this	Account	request
          Y                                                                                                  17.1 Subject to 17.2, the term of this Agreement starts on the date it is signed by the second
	      •		 heir	ability	to	access	that	information	in	accordance	with	the	Privacy	Act,	and
          T                                                                                                       party to do so and shall continue in force until and unless terminated by either party
	      •		 he	contact	details	of	our	Privacy	Officer	(The	Privacy	Officer,	American	Express	Australia	
          T                                                                                                       giving the other 3 months notice.
          Limited, 175 Liverpool Street, GPO Box 1582, Sydney NSW 2001).                                     17.2 Either party may terminate this Agreement immediately by notice at any time if the other
8.4    You agree that American Express and Qantas may exchange data relating to transactions                      is bankrupt, insolvent or unable to pay its debts or becomes involved in any action or
       on your Account and use it to calculate, verify, provide, record and determine your                        process (including a voluntary process) normally associated with insolvency, including,
       eligibility for benefits. You also agree that American Express and Qantas may use that                     without limitation, receivership, liquidation or statutory administration, or if it ceases to
       information to offer or inform you about selected services of Qantas and American                          carry on business in Australia.
       Express which we think may be of interest to you.                                                     17.3 On termination of this Agreement your Account will be closed and Cards will be
9.     Liquidated Damages for Late Payment                                                                        automatically cancelled. All Charges incurred before cancellation of the Account and Cards
       If you do not pay your account in full on receipt of the Cardmember monthly statement,                     are payable in accordance with this Agreement.
       you are in default. Therefore, you acknowledge that we may suspend or cancel your                     18. Notices
       charge privileges, and you agree that we may charge you liquidated damages as follows:                18.1 All notices under this Agreement must be in writing and marked for the attention of the
	      •	 If	we	do	not	receive	full	payment	of	the	‘Total	due’	billed	in	the	Cardmember	monthly	
           	                                                                                                      Program Administrator.
           statement by the date of the next statement, the unpaid balance will be identified on the         18.2 A party may change its notice details by giving notice to the other in accordance with this
           next statement as the ‘Overdue’ amount.                                                                Section.
                                                                                                             19. Governing Law
	         L
       •	 	 iquidated	damages	of	three	percent	(3%)	or	AUD$30,	whichever	is	greater,	will	be	charged	
                                                                                                                  This Agreement and all matters relating to the Account or Cards are governed by the laws
          on any Overdue amount which is identified in a statement and will be billed in that statement.
                                                                                                                  of New South Wales.
	      	 		 he	Overdue	amount	may	include	any	unpaid	liquidated	damages	billed	on	previous	
       •T
                                                                                                             20. Annual Fees
          statements.
                                                                                                                  We normally bill Card fees annually, based on our fee schedule as amended from time to
10.    Program Administrator
                                                                                                                  time, and you agree to pay such fees when billed, if you have chosen to receive central
       You agree to designate an employee (‘Program Administrator’) to assist us in operating
                                                                                                                  billing for such fees.
       your Account and Cards. You authorise the Program Administrator to act on your behalf
                                                                                                             21. General Provisions
       for all matters relating to this agreement. We are entitled to rely on directions, consents
                                                                                                                  We may change or assign this Agreement at any time and we will use our reasonable
       and information from your Program Administrator.
                                                                                                                  efforts to notify you of such changes. You will be bound by any change or assignment if
11.    Problems with Bills or Purchases
                                                                                                                  you subsequently use the Account.
       You are responsible for confirming the correctness of your monthly statement. If you dispute
       a charge, you must notify us at once. We will take reasonable steps to assist you. A disputed
       charge	fee	of	AUD$40	is	payable	if	you	ask	us	to	investigate	a	disputed	charge	on	your	Account	
                                                                                                               TO: AMERICAN EXPRESS AUSTRALIA LIMITED
       and that charge is found to be a valid charge. If a merchant issues a credit for a charge, we will
       credit the amount to your account on receipt. If a problem cannot be resolved immediately             We wish to introduce the American Express Corporate Card system, and we accept your
       then pending resolution of the problem, we may agree to place a temporary credit on any               Agreement set out above and the American Express Corporate Card Conditions accompanying
       disputed amount, but you must pay us for all other charges. Unless required by law, we are            each Corporate Card issued at our request. We warrant that the information contained in this
       not responsible for goods or services obtained with the Card, or if any merchant does not             application form is correct and authorise you to contact our bankers or any other party to
       accept the Card. You must raise any claim or dispute direct with the merchant concerned. You          obtain any information you require about our financial affairs.
       are not entitled to withhold payment from us because of such claim or dispute. You agree that         We understand that you may decline this application without giving a reason or entering into
       if requested to do so you shall provide us with written confirmation in relation to your claim        any correspondence. The individual signing below on behalf of the below named Company
       of unauthorised charges including without limitation, supplying any or all of the following,          warrants that he/she is authorised to do so.
       a statutory declaration, an affidavit of forgery and/or a copy of an official Police report. By
       reporting the existence of unauthorised charges, you agree to allow American Express to                 Company Decision Maker’s Signature
       release any information that you have provided or which is the subject of an investigation
       into the unauthorised charges to the Police and any other investigative or statutory authority.
       You also agree that when requested you shall provide all reasonable assistance and relevant
                                                                                                                ✘                                                                          Date   D D   /   M M   /   YYYY


       information to us and/or the Police in relation to your claim of unauthorised charges.                  Title
12.    Charges made in Foreign Currencies
       If you make a charge in a currency other than Australian dollars, that charge will be                   Name
       converted into Australian dollars. The conversion will take place on the date the charge is             (please print)
       processed by American Express, which may not be the same date on which you made your                    Position Held
       charge as it depends on when the charge was submitted to American Express. If the charge                in Company
       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                  Company Name
       Australian dollars. If the charge is in U.S. dollars, it will be converted directly into Australian
       dollars. Unless a specific rate is required by applicable law, you understand and agree that          (As per registered ABN Company Name)
       the American Express treasury system will use conversion rates based on interbank rates
       that it selects from customary industry sources on the business day prior to the processing
                                                                                                             Telephone Number                       –
       date,	increased	by	a	single	conversion	commission	of	2.5%.	If	charges	are	converted	by	third	
       parties prior to being submitted to us, any conversions made by those third parties will be at
                                                                                                             Fax Number                             –
       rates selected by them. Any refund transactions are processed at the date of the refund and
       you acknowledge that the refund amount may not be the same as the charge.                                Email Address*
13.    Third Party Software Provider
       If, at any time, whether before or after this Agreement comes into effect, we introduce
       or have introduced any third party software provider to the Company, the Company                      * If you wish to receive important information about your account, product offers and service updates from
       acknowledges and agrees that we make no representation nor warranty expressly or                        us via email please provide your email address.
       impliedly as to the functionality or reliability of any software provided by that third party to
       the Company, nor as to the availability, quality or duration of software support or upgrades
                                                                                                               AMERICAN EXPRESS OFFICE USE ONLY
       by the third party. Moreover, the Company acknowledges and agrees that we shall not be
       liable at all for the quality, merchantability or fitness for purpose of any software provided
       by a third party. The Company hereby agrees that its sole recourse for any damages suffered           Sales Code
       arising from the use of, or any aspect of the software, will be to the provider of the software.        Sales Name
14.    Our Responsibility
14.1   We shall provide you with reports and management information for your Account in the
       standard format we provide to Corporate Account customers. We do not represent or                     Sales Telephone Number                          –
       guarantee that you can rely on such reports or information being accurate or complete for
                                                                                                               Sales Email Address
       the purpose of complying with your tax or other legal obligations or for any other purpose.


                                                                                                                                                                                                                      P4 of 6
Simplify the Completion of your
Corporate Account Agreement and Set-Up



To assist in processing your Corporate Account Agreement and Set-Up, please
ensure you have completed all the required information using a black pen and block
letters before returning all forms to American Express. This will enable us to assess your
application efficiently and avoid delays in requesting additional information from you that
may not be complete. Please use the check boxes below as a guide to assist you.



❑	    	/We have signed the Corporate Account Agreement Terms and Conditions.
      I

❑	    I/We have completed all Corporate Details required on the Set-Up Form.

❑	    I/We have completed the Company Direct Debit Request.

❑	    I/We have completed all Employee Applications required for Corporate Cards.
     American Express Australia Limited ABN 92 108 952 085
                  americanexpress.com.au/cs
                  American Express Australia Company.
     ®Registered Trademark of American ExpressLimited ABN 92 108 952 085
                ®Registered Trademark of American Express Company.



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