AMERICAN EXPRESS® BUSINESS TRAVELLER PROFILE



AMERICAN EXPRESS? BUSINESS TRAVELLER PROFILEEmail: FORMTEXT N/A Fax: FORMTEXT N/A FORMCHECKBOX Mr. FORMCHECKBOX Ms. FORMCHECKBOX Mrs. FORMCHECKBOX Dr. (Please print information clearly) FORMTEXT ????? FORMTEXT ????? FORMTEXT ???? FORMTEXT ?????Traveller Surname – as shown on citizenship/passportFirst Name – legal nameInitialTitle FORMCHECKBOX Female FORMCHECKBOX Male Gender FORMTEXT Canadian Forces Morale and Welfare Services FORMTEXT ????? FORMTEXT ?????Company NameDivisionGL Number FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Company AddressCityProv.Postal Code FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Business PhoneExt.Fax NumberCell. Phone/ Pager NumberEmail Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Home Address*City*Prov.*Post. Code*Home Phone*Birth Date* (mm/dd/yr) FORMTEXT N/A FORMTEXT N/A FORMTEXT N/A FORMTEXT N/ATravel Arranger’s Name Travel Arranger’s Email addressBus. PhoneExt. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Passport Number (if available)*Expiry Date (mm/dd/yr)Citizenship FORMTEXT N/ARedress Number (if applicable)**OptionalCorrespondence: FORMCHECKBOX English FORMCHECKBOX Fran?ais Traveller PreferenceAirline Seating Choice: Please indicate 1st & 2nd choices1st Choice: FORMCHECKBOX Aisle FORMCHECKBOX Window FORMCHECKBOX Front FORMCHECKBOX Back2nd Choice: FORMCHECKBOX Aisle FORMCHECKBOX Window FORMCHECKBOX Front FORMCHECKBOX Back FORMCHECKBOX Smoking* FORMCHECKBOX Non-Smoking * All North American & most international flights are non-smokingList Airline, Hotel & Car Rental choices in order of importance:NB: your company’s preferred vendors will supercede your choices.Airline Preference1. FORMTEXT ?????3. FORMTEXT ?????2. FORMTEXT ?????4. FORMTEXT ?????Special Meal/Diet Requirements FORMCHECKBOX Diabetic FORMCHECKBOX Fruit Plate FORMCHECKBOX Kosher FORMCHECKBOX Muslim FORMCHECKBOX Vegetarian FORMCHECKBOX Low Cal FORMCHECKBOX Low Cholesterol/Fat FORMCHECKBOX Low Sodium FORMCHECKBOX Other: FORMTEXT ?????Hotel PreferenceCar Rental Preference 1. FORMTEXT ?????1. FORMTEXT ?????2. FORMTEXT ?????2. FORMTEXT ????? FORMCHECKBOX Smoking FORMCHECKBOX Non-Smoking FORMCHECKBOX Smoking FORMCHECKBOX Non-SmokingOther Special Instructions: FORMTEXT ?????Membership ProgramsFrequent Flyer Programs:*Note: To facilitate the proper transfer of frequent flyer points, it is the traveller’s responsibility to ensure that their name registered with the applicable airline membership program(s) is consistent with that on the airline ticket and therefore matches the entry above.Membership NumberProgram Name - as printed on Membership cardMembership NumberAeroplan FORMTEXT ?????Other Airline 1: FORMTEXT ????? FORMTEXT ?????Other Airline 2: FORMTEXT ????? FORMTEXT ?????Other Airline 3: FORMTEXT ????? FORMTEXT ?????Hotel MembershipsProgram Name - as printed on Membership cardMembership Number1. FORMTEXT ????? FORMTEXT ?????2. FORMTEXT ????? FORMTEXT ?????3. FORMTEXT ????? FORMTEXT ?????4. FORMTEXT ????? FORMTEXT ????? Car Rental MembershipsProgram Name - as printed on Membership cardMembership Number1. FORMTEXT ????? FORMTEXT ?????2. FORMTEXT ????? FORMTEXT ?????Payment Methods: You authorize American Express? Business Travel to:Card TypeCard NumberExpiry Date (mm/yr)Charge your business travel to: FORMTEXT N/A FORMTEXT N/A FORMTEXT N/ACharge your personal travel to: FORMTEXT N/A FORMTEXT N/A FORMTEXT N/AGuarantee your hotel reservation to: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Signature: FORMTEXT ?????Date: FORMTEXT ?????PRINT CARDHOLDER NAME: _____________________________________________Signature and date required.Submission of this document, including by e-mail or fax confirms your authorization to use the above noted Card(s) as well as understanding and acceptance of the following Privacy Notice which includes your consent to the collection, disclosure, use and processing of personal information for the purposes identified.E-MAIL TRANSMISSION DISCLAIMERYour privacy and the security of your sensitive and personally identifiable information are important to Amex Canada Inc. Unfortunately, no electronic transmission, including those made by e-mail can be guaranteed to be secure. If you are electing to send any such transmission electronically you recognize we are not responsible for the security of this information in transit and that you are sending sensitive or personally identifiable information to us only at your own risk. We will, however, handle all information upon receipt in a manner consistent with our Privacy Notice (attached below) including the safeguarding policies referred to in our Privacy Code.PRIVACY NOTICEYou are urged to read this Privacy Notice thoroughly as it relates to important matters dealing with your privacy rights. It includes your consent to the collection, disclosure, use and processing of your personal information for the purposes identified. It also provides some illustrative descriptions and examples to help you understand the nature of this personal information and how it relates to the purposes.In this Privacy Notice, the words “we”, “our” and “us” mean Amex Canada Inc., its parent and affiliates (including Amex Bank of Canada, a provider of financial related services), and their agents and service providers (acting on their behalf). “Personal information” is any information which relates to an individual and allows that individual to be identified (“Information”). “Company” means the legal entity in whose name the business travel account is opened.CONSENT TO USE OF PERSONAL INFORMATIONWe collect, disclose, use and process Information: (1) to consider initiating and to initiate, maintain and develop our relationship with you in connection with our offering products and services generally, including helping us to understand the current and future needs of our customers and to otherwise analyze and manage our business; (2) to administer billing and accounting services in relation to your business and the Company’s business with us; (3) to apply security measures which may include monitoring transactions or verifying Information about your background or to identify you; (4) as permitted by or to comply with law and regulatory requirements; (5) to, where the provision of services or benefits provided to you are offered by or include the participation of third party suppliers, share and exchange with such third party suppliers, and their agents and service providers, any Information reasonably required for the provision of the service or benefit; (6) to share or exchange Information with a travel arranger authorized by you; and (7) to share or exchange Information with the Company, and its parent or affiliates and their respective service providers and agents, which may include i) to process, consolidate and transmit Information to the Company’s third party service provider for the purposes of preparing reports, analysis and other such services to be made available to the Company by such third party service provider, and ii) transferring the Information to an alternative travel service provider of the Company. We will not use or provide your Information to third parties for direct marketing purposes. This will not limit information we may send to you with your travel documents or information we may provide you when you contact us. When you provide us with your e-mail address, our e-mail communications with you may include customer service and information notices in addition to travel information and documentation. You agree that we or reputable organizations selected by and acting for us, may from time to time monitor and / or record your telephone calls with us for the purposes of servicing accuracy, quality assurance, training and record keeping. We may use Information in our records for as long as it is needed for the purposes described above even after our relationship with you has ceased.You consent to our collection, disclosure, use and processing of Information for the purposes described above. You authorize third parties to give us the Information for these purposes. If you provide us with Information about any other individual, you confirm that the individual (i) has consented to our collection, disclosure, use and processing of that Information for these purposes as reasonably required and (ii) authorizes third parties to give us the Information for these purposes.NATURE OF INFORMATION COLLECTEDThe Information we collect from time to time may include: (1) Information to identify you such as name, title, employee identification number, date of birth, contact information, government issued documentation details (for example, a passport) and your background (for example, citizenship); (2) Information in relation to the provision of products and services (for example, language and travel preferences, emergency contact information, and loyalty or reward program information for communication to applicable suppliers); and (3) Information relating to transactions arising from your relationship with or through us (this includes travel reservation details and details about how you or the Company makes payments to us).We collect Information from various sources including from you directly through Business Traveller Profiles, reservation bookings and other communications, through the products and services you use, from others with your consent (such as the Company or a travel arranger authorized by you) or other permitted sources.In certain appropriate circumstances, we or others providing services through us may ask for health-related information for specific services (such as insurance) or requests (such as meal preferences on airlines). This type of Information will not be used for any purpose other than to address the specific service or request.We ask about your citizenship to help determine the documentation requirements for travel outside of Canada. We collect passport details because this Information may be required for certain travel destinations. We will review and analyze Information in various ways. For example, we may use Information in order to apply and monitor compliance with your Company’s travel policies. We may also monitor transactions using proprietary techniques to help identify transactions that may be of risk from a fraud or money laundering and terrorist financing perspective. This may involve assessing Information in relation to information from other sources including our own records to detect suspicious patterns or connections. YOUR CONSENT RIGHTSExcept in the limited circumstances where our use of Information is permitted or required by law, before using your Information for any new purposes we will explain them to you and seek your consent. Subject to legal and contractual restrictions, you can withdraw your consent to our use of your Information at any time with reasonable notice. If you refuse or withdraw your consent for any purpose that is required by us to fulfill our product or service contract with you or the Company, we will not be able to provide you, or continue to provide you, with the product or service.WE PROVIDE FILE ACCESSCustomers have access to Information that is reasonably available and retrievable in the ordinary course of business. Upon your written request, we will disclose to you the Information in your file, subject to certain limitations. You have the right to correct any Information which is inaccurate or incomplete. You can access this Information by writing to us at our head office located at 101 McNabb Street, Markham, Ontario, L3R 4H8, Attention: Compliance & Ethics Department, Protection of Personal Information. We will respond to a written request from you within thirty days of receipt or such other time as may be permitted or required by law. If for any reason we do not grant you access, we will provide you with written reason(s). If you wish to obtain a copy of any Information in your file, we will let you know beforehand if there will be a charge for this service.PRIVACY CODETo obtain more information about our policies and procedures in protecting your privacy visit our website at americanexpress.ca/privacy or call us at 1-888-301-5312 or 905-943-1197 to request a copy of our Privacy Code. ................
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