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Express Cash - Direct Debit
I wish to enrol in the Express Cash Service offered by American Express.
Each Express Cash transaction I make, whether for cash or American Express Travellers Cheques will be charged to the bank account
stated below.
1. Cardmember Information
First name
Last name
–
American Express Corporate Card number
–
2. Company Information
Company Name
Street
House number
Box
ZIP Code
Place
Country
3. Personal Identification Number (PIN Code)
The processing of a Secret Code takes about 3 weeks. By signing this application form, I declare that I have read the Terms and Conditions for the
use of Express Cash. Using this services implies accepting the Terms and Conditions.
Signature
Date
D
D M M Y
Y
Y
Y
Place
4. Direct Debit Instructions
The Direct Debit is mandatory to use the Express Cash Service. Please select:
The Direct Debit will only be applicable to the use of the Express Cash Service
The Direct Debit will be applicable to both Express Cash and Card Expenses
Please fill out the SEPA Direct Debit Mandate on the next page.
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PARTICULAR CONDITIONS OF USE FOR CORPORATE EXPRESS CASH
1. Scope of the Particular Conditions
a)Please read these Particular Conditions carefully. It sets out the terms of
your participation in the Express Cash Service (“the Service”) access which is
offered to you by American Express International Inc. (“American Express”).
Access to the machines used in the Service is controlled by the use of the
American Express Corporate Card issued to you by Alpha Card. If you use
the facilities offered to you under the Service you formally agree to the
terms of these Particular Conditions and your use of the facilities will be
governed by it.
b)In this Agreement, the words “you” and “your” refer to the Cardmember
who has applied to participate in the Service. “The Card” refers to the
American Express Corporate Card issued to you by Alpha Card. “The
Terminal” refers to any automated teller machine or other automated
authorisation process by which you may obtain cash under the terms of
the Service.
c)The participation to the Service is governed by the terms and conditions
for the use of the Corporate Card. The present Particular Conditions are
only an addition to these general terms and conditions. However, in case
of contradiction, the present particular conditions take precedence.
2. Personal Identification Number
a)In order to enable you to participate in the Service you have been
permitted to choose your own Personal Identification Number (“PIN”) for
use in connection with the Card. Each time you carry out a transaction at a
Termi-nal you must communicate your PIN to the Terminal after inserting
the Card. In addition, you must comply with any operating instructions
applicable in respect of any Terminal.
b)To ensure that no unauthorised transactions are made under the Service
you must keep your PIN strictly confidential and take all reasonable
precau-tion to prevent others from learning your PIN or using the Card.
Any record of the PIN should not be identifiable as such and should be kept
entirely separate from the Card.
3. Limits to Cash available under the Service
At present the limit on the value of cash which may be obtained from a
Terminal during any seven day period is 600 euro or its foreign currency
equivalent. These limits may be varied by American Express at its discre-tion,
in respect either of individual Terminals or of the Service as a whole. It is your
responsibility to ensure that in using the facilities offered under the Service
you do not exceed any limits which may apply to you.
4. Payment for Cash
By using the Card to obtain cash with the Service you agree to American
Express causing the debiting of your Card account or your bank account
through direct debit by American Express in Euros the amount of each
transaction which you effect at any Terminal. The value of the transaction
shall be the equivalent in Euros of the face value of the cash obtained
through the transaction plus applicable charges. The charges payable in
respect of transactions are set out in clause 5 below.
5. Charges
a)By obtaining cash purchased through a Terminal you will be charged a
fee of 3,5% of the value of the transaction, which will be subject to a
minimum fee of 3,10 euro in case of bank domiciliation. If you prefer that
these transactions appear on your Card Account, a fee of 3,9% of the value
of the transaction will be charged, with a minimum fee of 3,10 euro. This
will be calculated when the transaction takes place and will form part of
the amount of the transaction.
b)Foreign Charges: conversion will take place on the date the Charge is
processed by American Express, which may not be the same date on which
the Cardmember made the Charge as it depends on when the Charge was
submitted to American Express. If the Charge is not in U.S. dollars, the
con-version will be made through U.S. dollars, by converting the Charge
amount into U.S. dollars and then by converting the U.S. dollar amount
into the billing currency. If the Charge is in U.S. dollars, it will be converted
January 2014
directly into the billing currency. Unless a specific rate is required by
applicable law, the company understands and agrees that the American
Express treasury system will use conversion rates based on interbank rates
that it selects from customary industry sources on the business day prior
to the process-ing date, increased by a single conversion commission of
2%. If Charges are converted by third parties prior to being submitted to
us, any conver-sions made by those third parties will be at rates selected
by them.
6. Misuse of the Card or PIN
You must tell American Express immediately if the Card is lost or stolen or if
your PIN is disclosed to any other person. The quickest way to do this is by
telephone.
7. Liability for Transactions
a)Neither American Express nor any other organisation operating Terminals
to which you will have access under the Service shall be under any liability
to you in respect of any inability to perform or complete a transaction at a
Terminal as the result, whether direct or indirect, of:
I - the inability of a Terminal to complete a transaction whether because it
contains insufficient cash or for any other reason;
II - a Terminal or any associated data processing system or transmission
link not working properly;
III - any circumstances beyond the control of American Express or the
opera-tor of the Terminal or its or their agents or sub-contractors;
IV - any other exceptions stated in this Agreement.
b)Neither American Express nor any operator of a Terminal shall be under
any liability to you in respect of any failure in the arrangements for
settlement of transactions conducted at Terminals which are not the direct
result of their act or omission.
8. Withdrawal or Modification of Services
American Express and/or the operators of Terminals may at any time add to,
modify, suspend or withdraw any or all of the facilities available under the
Service without prior notification to you.
9. End of Participation
The participation to the Service may be terminated in the same manner as
the use of the Card.
10. Changes of the Particular Conditions
The Particular Conditions may be modified in the same manner as the
general terms and conditions.
11. Privacy and Applicable Law
a)In order to ensure the effective functioning of the Service it may be
necessary confidentially to transfer information about your Card Account
and your transactions under the terms of the Service within the American
Express Card Service worldwide and to make such information available
to the organisations operating Terminals at which you wish to conduct
transac-tions. However, the law on the protection of privacy of December
8th, 1992 will apply.
b)The operation of any Terminal is subject to laws and regulations applicable
in the location in which it is situated.
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European SEPA Direct Debit Mandate (for Express Cash)
For recurring debit
Core
Creditor name: Alpha Card scrl
Creditor ID: BE92ZZZ0463926551
Bld. du Souverain, 100, Vorstlaan
1170 Brussels
Belgium
–
Corporate Ref.
Card Holder Ref.
–
X X X X – X X X X X X –
Your Unique Mandate Reference will be communicated when the direct
debit has been set up.
1. Debtor identification
By signing this mandate form, you authorise A) Alpha Card scrl (identification number BE92ZZZ0463926551) to send instructions to your bank to
debit your account and B) your bank to debit your account in accordance with the instructions from Alpha Card scrl for the recurring payment of
your spend related to your American Express Account.
Payment by Company’s Bank Account*
Company Name
Company’s Mandated Person :
First name
Last name
Payment by Personal Bank Account*
First name
Last name
2. Debtor information
Street
House number
Box
ZIP Code
Place
Country
Bank account number (IBAN code) :
–
–
–
–
–
–
–
–
BIC Code
As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your
agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your
account was debited.
Signature
Date
D
D M M Y
Y
Y
Y
Place
Please fill out these documents and send them to :
Alpha Card scrl - Bld. du Souverain, 100, Vorstlaan - 1170 Brussels, Belgium
Fax +32 (0)2 676 21 91
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