8/19/2019 BPI Corp Card Form

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  BPI Express Credit Corporate Card – Cardholder InformationBPI Express Credit Corporate Card – Cardholder InformationSheetSheet

COMPANY NAME:

ADDRESS: c/o

CARDHOLDER INFORMATIONCARDHOLDER INFORMATION

NAME:

(Last) (First) (Middle)

NAME TO APPEAR ON CARD:

(Limit to 21 characters only!PO"T"ON "N T#E COMPANY:

EMPLOYEE NO$: C"T"%EN#"P:

DATE O& '"RT#: PLACE O& '"RT#: MALE &EMALE

TA "DENT"&"CAT"ON NO$:

MOT#ER) MA"DEN NAME:

CARDHOLDER ADDRESS/CONTACT INFORMATIONCARDHOLDER ADDRESS/CONTACT INFORMATION

#OME ADDRE: %"P CODE:

PERMANENT O&&"CE ADDRE: %"P CODE:

O&&"CE TELEP#ONE NO$:

 ALTERNATE O&&"CE ADDRE (i* any: %"P CODE:

CELLP#ONE$ NO$ : EMA"L ADDRE:

"n connection +ith the iss,ance o* the 'P" E-.ress Cre/it Cor.orate Car/0 the Com.any may enroll in the E-.ress Data Online (EDOL *acility0 +hich +illie the Com.any the o.tion to ie+ online the Car/hol/er)s transaction /etails$

The car/hol/er *,rther ,n/erstan/s an/ arees that in the eent o* the Com.any’s *ail,re to .ay0 the o3liations0 chares an/ lia3ilities inc,rre/ thro,hthe ,se o* the 'P" E-.ress Cre/it Cor.orate Car/ iss,e/ to its em.loyees0 or any .ortion thereo*0 the Car/hol/er e-.ressly allo+s 'P" to +ith/ra+0 cancelor s,s.en/ at anytime therea*ter any or all o* the 'P" E-.ress Cre/it Cor.orate Car/ .riilees an/ hol/s 'P" *ree an/ harmless an/ in/emni*ie/ *rom anyan/ all claims0 /amaes0 s,its0 an/ ca,ses o* action arisin *rom s,ch +ith/ra+al0 cancellation or s,s.ension$

'y sinin 3elo+0 the Car/hol/er arees to an/ shall 3e 3o,n/ 3y the terms an/ con/itions herein$ The Car/hol/er *,rther a,thori4es the Com.any toreceie co.ies o* an/5or ie+ online the Car/hol/er)s OA$

  66666666666666666666666666666666666666   CARD#OLDER "7NAT8RE

" am also intereste/ in sinin ,. *or a Personal BPI Express Credi card:

  Classic 7ol/ MasterCar/ Petron MasterCar/ 'l,e MasterCar/ E/e MasterCar/ 9yMiles MasterCar/E-istin 9yMiles Mem3er: Yes No "* yes0 Mem3ershi. No$ 6666666666666666666 

CARDHOLDER INFORMATION

NAME TO APPEAR ON CARD:(Limit to 21 characters only!

  "N7LE MARR"ED "DOED EPARATED5D";ORCED

NO$ O& DEPENDENT:

PRE&ERRED '"LL"N7 ADDRE: #OME O&&"CE

CARDHOLDER ADDRESS/CONTACT INFORMATION

#OME ADDRE:

#OME TELEP#ONE NO$ %"P CODE:

CELLP#ONE$ NO$ : EMA"L ADDRE:

OFFICE/B!SINESS INFORMATION

YEAR "T# &"RM: PO"T"ON:

 ANN8AL "NCOME:

SPO!SE

NAME:

(Last) (First) (Middle)

DATE O& '"RT# EMPLOYED EL& EMPLOYED

NAME O& O&&"CE5'8"NE: YEAR "T# &"RM:

PO"T"ON: T"N NO$:

M" O#er Credi Card/s:Cre/it Car/ Car/ N,m3er Cre/it Limit E-.iry

 

" aree an/ con*irm that this re<,est is /istinct an/ se.arate *rom the a3oe cor.orate car/ a..lication0 an/ any an/ all chares arisin *rom the ,se o* the.ersonal car/ is solely *or my acco,nt$ SI$NAT!RE : %%%%%%%%%%%%%%%%%%% 

'y sinin a3oe0 " certi*y that the in*ormation ien 3y me is tr,e an/ correct an/ that any material misre.resentation or *alsity therein shall 3e constr,e/ as an act to /e*ra,/'P" *or +hich ciil an/5or criminal lia3ility can 3e .,rs,e/ aainst me$ " here3y a,thori4e 'P" to: (i in<,ire a3o,t an/ inestiate all the /eclare/ in*ormation *rom +hateer so,rces 'P" may consi/er a..ro.riate= (ii ,se any contact /etails to comm,nicate to me *or +hateer .,r.ose= (iii /isclose any in*ormation herein .roi/e/ to any .erson or entity$ &or this .,r.ose0 " aree to in/emni*y an/ hol/ 'P" *ree an/ harmless *rom any an/ all claims0 lia3ilities0 /amaes0 s,its or ca,ses o* action o* +hateer nat,re0 no+ or herea*ter arisin *rom or in connection +ith the *oreoin a,thori4ation$ &,rther0 " aree that: (i the a..lication *orm an/ the relate/ /oc,ments s,3mitte/ to 'P" shall not 3eret,rne/ to me *or +hateer reason= (ii in case o* /isa..roal o* my a..lication0 'P" is ,n/er no o3liation to .roi/e me +ith the reason *or s,ch /ecision= an/ (iii 'P" reseresthe riht to restrict the ,se o* an/5or to terminate5cancel the car/ +itho,t the nee/ o* .rior notice *rom 'P"0 i* it is later /etermine/ that the in*ormation certi*ie/ 3y me is *alse$ "nthe eent that my a..lication is a..roe/0 my ,se o* the cre/it car/ shall 3e /eeme/ my acce.tance5areement +ith the terms an/ con/itions oernin the iss,ance an/ the,se o* the 'P" E-.ress Cre/it Car/ as .rinte/ at the 3ac9 o* the car/ carrier +hich " +ill receie toether +ith my cre/it car/$ " acce.t lia3ility *or all chares to the .rinci.al car/an/ s,..lementary car/s$ Any alterations0 amen/ments0 e-ce.tions0 reserations or scri33lins ma/e 3y me herein0 in the 'P" E-.ress Cre/it Car/ terms an/ con/itions0 as+ell as in the .roisions containe/ in the tatement o* Acco,nt (OA0 "nstallment Plan Contract0 Chare li.0 other car/ /oc,ments0 ,retyshi. Areement an/5or s,ch other relate/ instr,ments or /oc,ments0 not a..roe/ in accor/ance +ith 'P")s a..ro.riate .roce/,res0 shall not 3e ali/ an/ 3in/in$