AMERICAN EXPRESS/ AT&T CORPORATE EDGE BILLING
ENROLLMENT AUTHORIZATION FORM
Please fax completed form to: American Express Operations: (623) 492-3030
AT&T Operations (513) 458-1515
For Information about services call:
American Express Operations: (800) 468-7100 prompt 3
AT&T Operations: (800) 458-9409 ext. 1 (Customer Service Rep), 2 (Billing Question), or 3 (Technical Question)
Fax this form to both American Express and AT&T.
The company address can be domestic OR international.
SECTION A: CONTACT INFORMATION
Company Name:
Attention:
Address Line 1:
Address Line 2:
City
State
Zip Code
COUNTRY:
Phone:
Fax:
AT&T Sales Contact Name:
Address:
City
Phone
State
Zip
Code
Fax
American Express MAD/CSR Name:
Address:
City
Phone
State
Zip
Code
Fax
SECTION B: AT&T ENROLLMENT INFORMATION
1. Does the customer currently have AT&T Corporate Calling Cards?
Yes
No
If Yes, how many?
Account #
2. Is the customer aware that liability for Calling Card charges, appearing on the Corporate American
Express statements, are determined by the American Express Corporate Card Agreement?
(refer to AT&T bill or Corporate Calling Card)
If Yes, email the Calling Card report to Cash Products for a match. Please contact the Client’s AT&T
Account Executive to obtain the AT&T CEB report.
Yes
No
3. Future new AT&T cards processed via joint application should be mailed to:
Correspondence Contact
Card Member
4. Calling Cards Discount Plan: Customer is enrolled or will be enrolled in:
VTNS
SDN
ABN-U
*
* Select Value
SBR
*If new Select Value, a signed Select Value contract is attached:
Yes
No
*If ABN-U, list Account # 171
AMERICAN EXPRESS/ AT&T CORPORATE EDGE BILLING
ENROLLMENT AUTHORIZATION FORM
Section C: AMERICAN Express Corporate Card Enrollment Information
1. Does the customer currently have American Express Corporate Cards?
Yes
If Yes, how many are to be enrolled?
Billing Cycle(s)
Enroll Delete Option: Does the customer want the AT&T Calling Cards
Yes
automatically deleted if the American Express Corporate Cards are deleted?
No
No
SECTION D: ENROLLMENT AUTHORIZATION/REQUEST FOR IMPLEMENTATION
1. American Express CID number
AT&T Customer Number
(Headquarter Number)
2. List all basic control numbers (not individual Card member numbers) to be enrolled in Corporate Edge.
You do not have to enroll an entire American Express Corporate Card Hierarchy.
Auto: Allows all subsequent new Cardmembers added under each BCA to be enrolled in Corporate Edge
automatically when applying for an American Express Corporate Card. This enrollment eliminates
the need for a separate application/listing.
Partial: Allows only specified Cardmembers and new enrollees under each BCA to receive a Calling
Card. New enrollment will need to be determined on an individual basis at the time an American
Express Corporate Card application is received. *If the Client chooses to enroll Cardmembers
with their existing AT&T Calling Card, an attached listing of Amex Corporate Card and AT&T
Calling Card numbers is mandatory. Please indicate if the Client wishes to change to Auto
enrollment after initial implementation.
Amex Basic Control
Account Number
Check one for each Account #
Name of Company/
Auto Partial
Subsidiary
AT&T Parent Account
Use additional pages if necessary
By signing below, we understand that all of the American Express Corporate Cardmembers on the
enrolled account will automatically have their AT&T Corporate Calling Card charges appear on their
America Express bill. We authorize American Express to develop and send a list, which contains all
enrolled Card Account employees plus relevant maintenance to AT&T to issue Corporate Calling Cards.
__________________________________________________________________
Signature of Authorizing Officer:
Title: ___________________________ Date: ___________________________