Common use of AGREEMENT SIGNATURE Clause in Contracts

AGREEMENT SIGNATURE. TO: AMERICAN EXPRESS INTERNATIONAL (NZ), INC. The Entity named above (“You”)requests that American Express International (NZ) Inc provide the Corporate Payment products (“Accounts”) elected in this application. The undersigned officer has read the attached Terms and Conditions and agrees that on your behalf you will be bound by them and liable for charges in accordance with these Terms and Conditions. You authorise American Express International (NZ) Inc to contact your bankers or any other source, including but not limited to Credit Reporting Agencies to obtain any information American Express requires to establish the chosen Accounts. You agree that a microfilmed or other reproduction of this form may be produced by American Express as evidence of your request to open the chosen Account(s). The undersigned warrants to American Express that he/she is duly authorised by you to open the chosen Account(s) in the name of the above Entity. Title First Name Last Name Position Company Name (As per registered Company Name) Telephone Number Fax Number – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Decision Maker’s Address14 City Postcode Date of birth D D / M M / Y Y Company Decision Maker’s Signature14 ✘ Date D D / M M / Y Y Y Y

Appears in 3 contracts

Samples: business.americanexpress.com, business.americanexpress.com, business.americanexpress.com

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AGREEMENT SIGNATURE. TO: AMERICAN EXPRESS INTERNATIONAL (NZ), INC. The Entity named above (“You”)requests You”) requests that American Express International (NZ) Inc provide the Corporate Payment products (“Accounts”) elected in this application. The undersigned officer has read the attached Terms and Conditions and agrees that on your behalf you will be bound by them and liable for charges in accordance with these Terms and Conditions. You authorise American Express International (NZ) Inc to contact your bankers or any other source, including but not limited to Credit Reporting Agencies to obtain any information American Express requires to establish the chosen Accounts. You agree that a microfilmed or other reproduction of this form may be produced by American Express as evidence of your request to open the chosen Account(s). The undersigned warrants to American Express that he/she is duly authorised by you to open the chosen Account(s) in the name of the above Entity. Title First Name Last Name Position Company Name (maximum 40 characters) (As per registered Company Name) Telephone Number Fax Number – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) In order I would like to comply with the Anti-Money Laundering enrol for BTA Reports YES NO Spend Comparison Report DHTML Airline Usage Report DHTML Trip Requisition Analysis DHTML Traveller Analysis Report DHTML Customer Reference Analysis DHTML Top 10 Air Routings Report DHTML Do you have an existing @ Work User ID ? YES NO If Yes, please provide your User ID If No, please provide your day and Countering Financing month of Terrorism Act 2009 birth. You will be prompted to enter this as authentication when completing your online registration to American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker@ Work. We will not be able to process your application without this information. Decision Maker’s Address14 City Postcode Date of birth D D / M M / Y Y 13(b). Additional Statement Recipient Title First Name Last Name Telephone Number Mailing Address City Postcode We need an email address to send the Company Decision Maker’s Signature14 ✘ Date D D / M M / Y Y Y Ychanges to the Terms and Conditions, servicing and marketing communications from American Express. Email Address

Appears in 2 contracts

Samples: business.americanexpress.com, business.americanexpress.com

AGREEMENT SIGNATURE. TO: AMERICAN EXPRESS INTERNATIONAL (NZ), INC. AUSTRALIA LIMITED The Entity named above (“You”)requests You”) requests that American Express International (NZ) Inc Australia Limited provide the Corporate Payment products (“Accounts”) elected in this application. The undersigned officer has read the attached Terms and Conditions and agrees that on your behalf you will be bound by them and liable for charges in accordance with these Terms and Conditions. You authorise American Express International (NZ) Inc Australia Limited to contact your bankers or any other sourcesources and/or reports, in relation to our organisation including from, but not limited to Credit Reporting Agencies to obtain any information to, credit reporting or other similar agencies for the purpose of identity verification of individuals named by us (whether in this application or otherwise) or identified by American Express requires before, during or after providing services to us to establish the chosen Accounts. You agree that a microfilmed or other reproduction of this form may be produced by American Express as evidence of your request to open the chosen Account(s). The undersigned warrants to American Express that he/she is duly authorised by you to open the chosen Account(s) in the name of the above Entityentity in his/her capacity as (PLEASE TICK ONE): Director, if a Company, including where Company is a Trustee Partner, if a Partnership Chairperson, President, Secretary, or Treasurer if an Association/Co-operative If the Company is a Trustee, the Trustee enters into this Agreement in its own right and as trustee of the Trust. Title First Name Last Name Position Company Name (As per registered Company NameABN entity name) City State Postcode Telephone Number Fax Number – We need an Your email address will be used to send the Company changes you online statement and servicing notifications and marketing. Please also refer to the Terms Section 19. Before you submit this form, check that you have provided true and Conditions, servicing and marketing communications from American Expresscorrect information. Email Address (Mandatory) In order to comply with It is an offence under the Anti-Money Laundering and Countering Counter-Terrorism Financing of Terrorism Act 2009 American Express International (NZ) Inc is required Xxx 0000 to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customerknowingly provide false, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this incomplete or misleading information. Business Email Address Decision Maker’s Address14 City Address12 Company Name (maximum 40 characters) Position Full Name State Postcode Date Your email address will be used to send you online statement and servicing notifications and marketing. Please also refer to Section 19. Business Email Address I would like to enrol for BTA Reports YES NO Spend Comparison Report DHTML Airline Usage Report DHTML Trip Requisition Analysis DHTML Traveller Analysis Report DHTML Customer Reference Analysis DHTML Top 10 Air Routings Report DHTML Do you have an existing @ Work User ID? YES NO If Yes, please provide your User ID If No, please provide your day and month of birth birth. You will be prompted to enter this as authentication when completing your online registration to American Express @ Work. D D / M M / Y Y Company Decision Maker’s Signature14 ✘ Date 11(b). Additional Statement Recipient Full Name Telephone Number Mailing Address City State Postcode Your email address will be used to send you online statement and servicing notifications and marketing. Please also refer to Section 19. Business Email Address I would like to enrol for BTA Reports YES NO Spend Comparison Report DHTML Airline Usage Report DHTML Trip Requisition Analysis DHTML Traveller Analysis Report DHTML Customer Reference Analysis DHTML Top 10 Air Routings Report DHTML Do you have an existing @ Work User ID? YES NO If Yes, please provide your User ID If No, please provide your day and month of birth. You will be prompted to enter this as authentication when completing your online registration to American Express @ Work. D D / M M / Y Y Y YAEX9559 09/21

Appears in 1 contract

Samples: www.americanexpress.com

AGREEMENT SIGNATURE. TO: AMERICAN EXPRESS American ExpresS INTERNATIONAL (NZ), INC. The Entity named above (“You”)requests that American Express International (NZ) Inc provide the Corporate Payment products (“Accounts”) elected in this application. The undersigned officer has read the attached Terms and Conditions and agrees that on your behalf you will be bound by them and liable for charges in accordance with these Terms and Conditions. You authorise American Express International (NZ) Inc to contact your bankers or any other source, including but not limited to Credit Reporting Agencies to obtain any information American Express requires to establish the chosen Accounts. You agree that a microfilmed or other reproduction of this form may be produced by American Express as evidence of your request to open the chosen Account(s). The undersigned warrants to American Express that he/she is duly authorised by you to open the chosen Account(s) in the name of the above Entity. Title First Name Last Name Position Company Name (As per registered Company Name) Telephone Number Fax Number – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Email Address (Mandatory) In order to comply with the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 American Express International (NZ) Inc is required to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customer, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this information. Decision Maker’s Address14 City Postcode Date of birth D D / M M / Y Y Company Decision Maker’s Signature14 ✘ Date D D / M M / Y Y Y Y

Appears in 1 contract

Samples: business.americanexpress.com

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AGREEMENT SIGNATURE. TO: AMERICAN EXPRESS INTERNATIONAL (NZ), INC. AUSTRALIA LIMITED The Entity named above (“You”)requests You”) requests that American Express International (NZ) Inc Australia Limited provide the Corporate Payment products (“Accounts”) elected in this application. The undersigned officer has read the attached Terms and Conditions and agrees that on your behalf you will be bound by them and liable for charges in accordance with these Terms and Conditions. You authorise American Express International (NZ) Inc Australia Limited to contact your bankers or any other source, including but not limited to Credit Reporting Agencies to obtain any information American Express requires to establish the chosen Accounts. You agree that a microfilmed or other reproduction of this form may be produced by American Express as evidence of your request to open the chosen Account(s). The undersigned warrants to American Express that he/she is duly authorised by you to open the chosen Account(s) in the name of the above Entityentity in his/her capacity as (PLEASE TICK ONE): Director, if a Company, including where Company is a Trustee Partner, if a Partnership Chairperson, Secretary, or Treasurer if an Association/Co-operative Other (Please specify role): If the Company is a Trustee, the Trustee enters into this Agreement in its own right and as trustee of the Trust. Title First Name Last Full Name Position Company Name (maximum 40 characters) (As per registered Company ABN Entity Name) Decision Maker’s Address12 City State Postcode Telephone Number Fax Number – – We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Business Email Address (Mandatory) In order to comply with Before you submit this form, check that you have provided true and correct information. It is an offence under the Anti-Money Laundering and Countering Counter-Terrorism Financing of Terrorism Act 2009 American Express International (NZ) Inc is required Xxx 0000 to gather identification information (including residential address and date of birth) on those individuals that are authorised to act on behalf of the customerknowingly provide false, this includes the Authorised Signatory, Programme Administrator and the Decision Maker. We will not be able to process your application without this incomplete or misleading information. Decision Maker’s Address14 City Postcode Date of birth D D / M M / Y Y Company Decision Maker’s Signature14 Signature12 ✘ Date D D / M M / Y Y Y YY State Postcode We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Business Email Address I would like to enrol for BTA Reports YES NO Spend Comparison Report DHTML Airline Usage Report DHTML Trip Requisition Analysis DHTML Traveller Analysis Report DHTML Customer Reference Analysis DHTML Top 10 Air Routings Report DHTML Do you have an existing @ Work User ID? YES NO If Yes, please provide your User ID If No, please provide your day and month of birth. You will be prompted to enter this as authentication when completing your online registration to American Express @ Work. D D / M M 11(b). Additional Statement Recipient Full Name Telephone Number Mailing Address City State Postcode We need an email address to send the Company changes to the Terms and Conditions, servicing and marketing communications from American Express. Business Email Address I would like to enrol for BTA Reports YES NO Spend Comparison Report DHTML Airline Usage Report DHTML Trip Requisition Analysis DHTML Traveller Analysis Report DHTML Customer Reference Analysis DHTML Top 10 Air Routings Report DHTML Do you have an existing @ Work User ID? YES NO If Yes, please provide your User ID If No, please provide your day and month of birth. You will be prompted to enter this as authentication when completing your online registration to American Express @ Work. D D / M M Product Type Non Standard Sliding Scale Fixed Amount

Appears in 1 contract

Samples: business.americanexpress.com

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