AMERICAN EXPRESS CORPORATE CARD

Personal details

Company details

Summary

Submit and Sign

Please register:

Digitally

With an eID cardreader
With itsme

Manually

With your ID Card at hand

On the summary page, we ask you to review the information you provided us with and to accept the Terms and Conditions.

The application form can be signed electronically.

At the same time the form is sent to the selected Program Administrator for approval.

Card Type

Billing and Settlement terms

Liability Type

I cannot be identified by these services

ID

Please provide

For residents in Belgium, copy/picture (both sides) of valid Belgian ID.
For all others, copy/picture (both sides) of valid EU Identity card or valid international passport and a copy/picture of your Belgian residence card or official registration document from the town - Annexe 8, 15, 19 or 49)

Allowed format: PDF, JPG Upload copy ID

ID Card number

Date of birth

Place of birth

ID expiry date

Country of birth

Title

Official first and middle names

Last Name

Street (legal address)

Number

Box

Postal Code

City

Country

Nationality

Mobile phone

Company telephone number

Company email address

Correspondence Address

Residential address

Office

Company

Street

Number

Box

Postal Code

City

Country

Different residential address

N/A

Street

Postal Code

City

N/A

Upload copy ID

Allowed format: PDF,JPG

Bank account number (IBAN)

Gross annual income in EUR

Payment method

Direct Debit

Bank transfer

SEPA-Direct Debit Mandate

SEPA-Direct Debit Mandate By signing this mandate form, you authorise A) American Express (identification number BE39ZZZ0776653759) to send instructions to your bank to debit your account and B) your bank to debit your account in accordance with the instructions from American Express for the recurring payment of your spend related to your American Express Account.

By signing, you agree that the signature is valid for both the SEPA Mandate as well for the underlying Corporate Card contract (“Contract”). The termination,for any reason, of the SEPA Mandate during the course of the Contract does not imply the termination for the Contract. The Contract can only be terminated through the usual termination process, as per the Terms and Conditions.

Mother's first name

Correspondance language

By clicking Next, you agree to let American Express retain your information and contact you about the status of your application in accordance to Cardmember Terms and Conditions.

Mandatory field

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American Express Corporate Card