COMPANY CONTACT DETAILS. 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. Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – 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) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – 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) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Title First Name Last Name Position Mailing Address (if different from Company Address) 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) Residential Address City Postcode City Date of birth D D / M M / Y Y 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. 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. Residential Address City Date of birth D D / M M / Y Y I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Title First Name Last Name Position Mailing Address (if different from Company Address) City # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Title First 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) Last Name Position Mailing Address (if different from Company Address) City Postcode Telephone Number – Fax Number –
Appears in 2 contracts
Samples: Corporate Account Agreement, Corporate Account Agreement
COMPANY CONTACT DETAILS. 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. Authorised Signatory2 (for future Application authorisation) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – 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) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Authorised Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Additional Authorised Signatory2 (recommended) Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – 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) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Authorised Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Credit Control7 (Optional) Title First Name Last Name Position Mailing Address (if different from Company Address) 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) Residential Address City Postcode City Date of birth D D / M M / Y Y Postcode Telephone Number – Fax Number Postcode – – 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. Residential Address City Date of birth D D / M M / Y Y I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Title First Name Last Name Position Mailing Address (if different from Company Address) City # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Title First 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) Last Name Position Mailing Address (if different from Company Address) City Postcode Telephone Number – Fax Number –
Appears in 2 contracts
Samples: Corporate Account Agreement, Corporate Account Agreement
COMPANY CONTACT DETAILS. 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. Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – 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) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Title First Name Last Name Position Mailing Address (if different from Company Address) City Telephone Number Fax Number Postcode – – 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) Residential Address City Postcode Date of birth D D / M M / Y Y Authorising Signatory’s Signature (Mandatory) ✘ Date D D / M M / Y Y Y Y Title First Name Last Name Position Mailing Address (if different from Company Address) 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) Residential Address City Postcode City Date of birth D D / M M / Y Y 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. 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. Residential Address City Date of birth D D / M M / Y Y I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Date of birth D D / M M / Y Y Postcode Title Last Name First Name Last Name I would like to enrol for @ Work Online Program Management YES NO I would like access to: Standard Reports Customised Reporting Position Mailing Address (if different from Company Address) City # Note – A minimum of 4 alpha/numeric characters to a maximum 20 (lower case only). No spaces or special characters allowed. Title First 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) Last Name Position Mailing Address (if different from Company Address) City Postcode Telephone Number – Fax Number –
Appears in 2 contracts
Samples: Corporate Account Agreement, Corporate Account Agreement