CORPORATE ONLINE PAYMENT PROGRAM ENROLLMENT FORM
Thank you for your interest in the American Express Corporate Online Payment program (“Program”). Participating in this Program
will enable your Company to pay its American Express Corporate and Purchasing bills online. Please contact American Express at
(888) 888-9634 for help with this form or the enrollment process.
To enroll in the Program, please:
1. Carefully read the instructions below and complete the form.
2. Carefully review the Program Terms & Conditions, then sign and date the form in the spaces provided.
3. Fax all three pages of the completed form to American Express at 623.707.4866.
4. The Authorized Banking Officer (“ABO”) whom you designate below will receive a confirmation e-mail at the e-mail
address provided within 5-7 business days. The ABO can then complete your Company’s enrollment online by clicking
the Manage Enrollment link on the American Express @ Work home page, entering your company’s bank account
information, and submitting the names of Authorized Payers.
STEP 1: Authorized Banking Officer (ABO) Designation
You must designate an ABO to participate in the Program. Your ABO’s rights and responsibilities are described in the terms below.
Designate your Company’s ABO below by providing the requested information.
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Company Name
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First Name
Middle Initial
Last Name
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Street Address
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City
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E-mail Address
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State
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Zip Code
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Business Phone
Step 2: Verification Word and PIN for ABO’s First Login
Your ABO will be prompted for a verification word (password) and PIN and required to create a permanent password upon their first
login to American Express @ Work. Create a temporary verification word and PIN below. Record in a safe place.
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____________________
Verification Word (Must be 4-20 alphanumeric characters)
Verification PIN (Must be exactly 4 digits)
STEP 3: ABO Payment Authorization
Your ABO can authorize individuals, including him/herself, to make online payments on the Company’s behalf. Do you want to give
the ABO the ability to make online payments at this time?
YES, give the ABO the ability to make online payments on the control accounts listed below.
NO, do not give the ABO the ability to make online payments at this time.
(Note: You can change this in the future by calling American Express at 1 (888) 888-9634.)
STEP 4: Corporate Program Information
For Purchasing products, your RCA (ICA) appears on your fanfold billing statement. To list more RCAs ( ICAs), please call
1-888-888-9634 after your ABO receives a confirmation e-mail. Please provide the following information.
Corporate Purchasing Solutions
CPS CID: __________________
__________________
__________________
__________________
Remittance Control Account 1
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Remittance Control Account 2
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Remittance Control Account 3
__________________
Remittance Control Account 4
Remittance Control Account 5
Remittance Control Account 6
Corp. Card CID __________
Master Control Acct ____________________
Corporate Card
STEP 5: PROGRAM TERMS AND CONDITIONS. Located on next page. Review and keep a copy for your records.
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CORPORATE ONLINE PAYMENT
TERMS & CONDITIONS
These Terms & Conditions (“Terms”) govern you and your company’s (collectively “You” and “Your”) participation in and use of the
American Express Corporate Online Payment Program (“Program”). In addition to these Terms, Your use of this Program is subject to
and governed by Your Cardmember Agreement and all other applicable terms delivered with same or posted on the Program website
(“Site”).
Authority. By enrolling and/or participating in the Program, You, individually and on behalf of Your company, are authorizing
American Express Travel Related Service Company, Inc. (“American Express”, “We”, “Our” or “Us”) to pay, as directed by You and
the personnel You authorize pursuant to the Terms herein, Your American Express Corporate and Purchasing account (Your “Amex
Account”) bills online in the amounts and upon the timing You specify from the bank/financial institution account You designate
(“Designated Account”). You represent and warrant that the Designated Account is established and used primarily for business
purposes.
ABO Designation. You must designate an Authorized Banking Officer (“ABO”) to participate in the Program. Your ABO is the only
person with the authority to set up, access, modify, and delete information about the financial institution account that Your Company
uses for this Program. Your ABO can also authorize others to make online payments for Your Company. You may de-authorize an
ABO at anytime by completing a new enrollment form and designating a new ABO.
We reserve the right to request further documentation verifying same, from You or Your Company and/or the right to reject Your
designation of an ABO or Your Company’s participation in the Program at anytime, for any reason. You agree to cooperate in Our
efforts related to same.
ABO Rights & Responsibilities. You represent Your ABO is authorized to act on behalf of Your Company regarding matters related
to Your Company's banking and financial institutions and the respective accounts to which Your Company maintains with said
institutions. Your ABO’s authority to act as such will begin within 5-7 business days of receipt and acceptance of the fully executed
version of this document and will end when You or American Express revokes it. Your ABO and Your Company are solely
responsible for promptly notifying American Express if Your ABO’s authorization has been revoked, suspended or otherwise
terminated (unless American Express itself issues the revocation).
Authorized Bank Account Users. Your ABO is responsible for designating Your Authorized Bank Account Users ("Authorized
Users"). Your Authorized User should be the person primarily responsible for repayment of Your Amex Account. Your ABO can
revoke said designation at anytime in his/her sole discretion. Authorized Users make payments and perform related tasks (i.e.
scheduling payments and viewing payment history) on Your Company's behalf for Amex Accounts of which the Authorized User is
assigned such rights by the ABO. Your ABO may designate up to 3 such Authorized Users online. The ABO may designate
her/himself as an Authorized User.
Conflicting Instructions. In the event there is any conflict between instructions received from an Authorized Bank Account User and
Your ABO, Your ABO’s instructions will take priority to the extent We are aware of both sets of instructions.
Responsibility for ABO and Authorized Users Actions. Your Company is solely responsible for the actions taken by Your
designated ABO and the Authorized Users and therefore agree Your Company will forever hold American Express harmless and not
liable for any debit or fraud losses arising from actions taken by Your ABO or the Authorized Bank Account Users Your ABO
designates.
Revocation of Authority. You are solely responsible for timely notifying American Express of any revocation, suspension or
termination of Your ABO’s or Authorized Bank Account User(s) authorized status and acknowledge failure to do so may adversely
impact Your Company's ability to make payments online and possibly cause Your Company to incur late fees, penalties or other
claims.
Payments. You, through Your Authorized User(s), are responsible for scheduling the timing and amount of all payments made through
the Program. Unless You notify American Express to stop or adjust the amount of a scheduled payment, in accordance with the
procedures set forth below, American Express is authorized to debit the funds from the Designated Account in the amount You specify.
You are also solely responsible for the timely repayment of Your Amex Account. You must ensure there are sufficient funds in the
Designated Account on the specified scheduled payment date. If payments scheduled, made or attempted to be made through this
Program do not satisfy Your Company's total monthly amount due, for any reason, Your Company will remain solely responsible for
remitting additional payments before the total monthly amount due is due, to fully satisfy Your contractual obligation for timely
payment. You understand all payments will occur on the date scheduled but may take up to 48 hours to process.
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If any scheduled payment is not honored by Your bank, We have the right to charge the amount of any such transaction to Your
Account or to collect the amount from You. If this happens, We may also cancel Your right to participate in the Program.
Stopping or Adjusting Pending Payments. If You want to stop a scheduled payment or make an adjustment to the amount of pending
scheduled payment, Your Authorized Users can do so on the Site’s “Pending Payments” page. Pending scheduled payments can be
cancelled or modified until 12:00 a.m. Pacific Time on the scheduled payment date.
Unauthorized Transactions, Prompt Reporting Obligations. In case of errors or in the event You believe someone using this
Program has transferred or may transfer money from Your Designated Account without Your permission call us immediately at 1 (888)
888-9634 anytime.
Liability for Failure to Transact Scheduled Payment. If a transaction is not completed as You have directed or if We do not
complete a transfer to or from Your Designated Account on time in the correct amount, We will be liable for Your losses or damages.
However, there are some exceptions. We will not be liable to You in the following instances: (1) If, through no fault of ours, Your
account does not contain enough money to complete the transaction; (2) If the funds in Your account are subject to legal process or
other encumbrance restricting the transaction; or (3) If circumstances beyond Our reasonable control prevent the transaction.
In Case of Errors. If You believe a transaction was performed in error, please call American Express as soon as possible following
the date of the error at 1 (888) 888-9634.
Termination. Your ABO may terminate Your Company’s participation in the Program by clicking the “Cancel Program” button
located on the Corporate Online Payments Enrollment page or by calling American Express at 1 (888) 888-9634 to request the deletion
of Financial Institution information and all Authorized Bank Account Users. No such requests will in anyway delay, lessen or
otherwise change Your outstanding payment obligations to American Express. All requests must be made at least three (3) days prior
to all scheduled payments. If You wish to use the Program again, You will be required to re-enroll. We reserve the right to terminate,
suspend or otherwise revoke the Program and/or Your right to participate in the Program at anytime for any reason.
Closing Amex Accounts. If Your Account is closed, You agree to notify us and will stop initiating Program transactions. In the event
Your Account is closed/cancelled and a balance remains on Your account, We will process all scheduled payments as directed by You.
Designated Accounts. You are solely responsible for keeping Your Designated Account information up to date and notifying us of
any update or change in said information.
Entire Agreement, Assignment. This agreement terminates and takes the place of all prior agreements You may have with us relating
to the Program using the Card. We have the right to assign this Agreement to a subsidiary or affiliate Company at any time.
Business Days. For purposes of the Program, business days are Monday through Friday. Holidays are not included. If the scheduled
payment date is on a weekend or banking holiday, the payment will be made on the next business day.
Contact Us. If for any reason You wish to contact us about the Program, about Your participation in the Program or about transactions
related to the Program, write or call us at (888) 888-9634.
STEP 6: ENROLLMENT & CONSENT TO TERMS
By faxing Us a signed copy of these terms, You signify to Us:
(1) You unconditionally agree to the Terms,
(2) You have all necessary corporate authority to agree to the Terms and designate an ABO as provided herein, and
(3) the person You designate as ABO, currently has or will have, before acting in such capacity, all necessary
corporate authority to be so designated and, from the date designated until revocation of such designation, act as Your
Company's "Authorized Banking Officer" as that position is described herein.
Upon satisfactory receipt and review of this completed form, We will enroll You into the Program.
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Signature
Company
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Printed Name
Signature Date
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Title
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