AMERICAN EXPRESS CORPORATE GOLD CARD UPGRADE APPLICATION AMERICAN ...

AMERICAN EXPRESS? CORPORATE GOLD CARD UPGRADE APPLICATION AMERICAN EXPRESS? EXECUTIVE CORPORATE CARD APPLICATION

Application Information - Application cannot be processed without required information Please upgrade the following Card Member(s) (collectively, the "Applicants") to the Corporate Gold Card:

Card Member Name* Required

E-Mail Address* Required

Card Number

Program Administrator: *Required fields must be completed or application cannot be processed. All upgrade applications require a signature (name & title) of an authorized Company Representative or Program Administrator

Please complete and send to: American Express P.O. Box 53800 Phoenix, AZ 850723800 Or Fax to: 623-492-3884

Program Administrator - Application cannot be processed without required information

Basic Control Number (*Required - please fill out or application cannot be processed)

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Company Name ("Company") (20 characters only, including spaces)

Authorizing Signature* Please read the Agreement before signing. I am authorized to complete this enrollment authorization on behalf of the Company

X

PRINT Authorizer's Name

Title

Date

Phone Number - -

PRINT Program Administrator ("PA") Name *May be previously filled out by PA

PA Phone Number - -

AGREEMENT: Company (a) requests that a Corporate Gold Card be issued to the Applicants on the Company's account, (b) authorizes the receipt and exchange of credit information on the Company and the Applicants, and (c) agrees that the Corporate Gold Card will be used for business or commercial purposes only. ** We may notify you about important account updates and services that may be suited to your needs. We will never share your email address. For information about how we protect our privacy, please visit privacy

Rev 2/2014

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