By submitting this application, I ask that an account be opened in my name and "Card(s)" issued as I request, and that you renew and replace them until I cancel. I agree to be bound by the agreement governing my account. I understand that the Agreement governing the Account includes an arbitration provision, which impacts my opportunity to have claims related to the Account heard in court or resolved by a jury, and to participate in a class action or similar proceeding. I understand that the agreement governing the Account also provides, among other things, that the Account terms, including the APRs and fees, are subject to change. I agree to be liable for all charges to my account, including charges incurred with any Additional Card(s) issued on my account now or in the future.

I understand that I must provide all the information requested in this application and I certify that such information is accurate. I authorize you to verify the information on this application and to receive and exchange information about me including requesting reports from consumer reporting agencies. If I ask whether or not a consumer report was requested, you will tell me, and if you received a report, you will give me the name and address of the agency that furnished it. I authorize you and your affiliates and subsidiaries to contact these sources for information at any time and to use any information obtained about me for marketing and administrative purposes.

Only qualified individuals 18 or over may be approved for the Card.

Additional Cards: I have advised Additional Card applicant(s) that you may obtain, verify, exchange and use information about them in the same manner as described above, that they may be responsible for payment of their own charges if I fail to pay them, and that their own credit records may be affected by non-payment of the account. I understand that Additional Card(s) will not be issued to me if I have an unsatisfactory account with American Express or if the Additional Card applicant(s) have ever had an unsatisfactory account with American Express.

I acknowledge that any benefit or service offered with the Card may be modified or terminated at any time.

This offer is not available to residents of Puerto Rico.

Express Cash: Your Card may be enrolled in the Express Cash feature, which provides access to cash advances, up to your cash advance limit, at participating ATMs. If your Card is enrolled, you will receive a letter that includes a system generated Personal Identification Number (PIN).

An applicant, if married, may apply for a separate account.

Information on Balance Transfers. If I have been offered and accepted an opportunity to transfer balances on credit cards to American Express Centurion Bank ("AECB"), I authorize AECB to forward payment on my behalf on the account(s) indicated in my application to the related account-issuing bank(s). I understand that my American Express Credit Card account will be debited for the total approved transfer amount requested up to my available line of credit. If my request exceeds the available credit line or amount approved, the transfer request may be honored and processed in part for a lower amount than requested, or the transfer request may be declined. I understand that finance charges will begin to accrue at the time a check is issued to my current credit card institution. I certify that the account listed on my application is in good standing, and I agree to maintain its current status at least until AECB has forwarded payment on my behalf. I agree to keep paying the current minimum payment on the account until confirmation appears on my American Express Credit Card statement. I will be responsible for the account as long as it remains open and for closing the account if I choose. I understand that transfers may take five to six weeks. I understand I cannot transfer balances from any other account issued by American Express or any of its affiliates.

I authorize AECB to verify the status and balance of such accounts, and understand that AECB may, at its discretion, deny a transfer request for any reason in its sole discretion. Balance Transfers are restricted to Basic Cardmembers only. Additional Cardmembers may not request or authorize any Balance Transfers to the Basic Cardmember's American Express Credit Card account.
Patriot Act Notice: Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account, including your name, address, date of birth and other information that will allow us to verify your identity.
Notice to Married Wisconsin Residents: No provision of any marital property agreement, unilateral agreement, or court decree under Wisconsin's Marital Property Act will adversely affect a creditor's interest unless, prior to the time credit is granted, the creditor is furnished a copy of that agreement or decree or is given complete information about the agreement or decree.

Note For Ohio Residents: The Ohio law against discrimination requires that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.


SUMMARY OF THE ACCOUNT PROTECTOR PROGRAM FROM AMERICAN EXPRESS
The Account Protector Program is an optional feature and is not required to obtain credit. For a monthly fee of 85¢ per $100 of your month end account balance, some or all of your account balance will be cancelled if you experience one of the qualifying events while enrolled. If you become involuntarily unemployed, hospitalized, disabled, take a covered leave of absence, or experience one of the covered life events (marriage, purchase of new home, relocation of more than 150 miles, starting college, divorce, birth or adoption of child(ren), death of spouse, or call to active military duty), we will cancel your minimum monthly payment as of the date of the event up to 24 months depending on the type and length of the qualifying event. You remain responsible for making payments when due on your account, including accumulated finance charges and fees, when the debt cancellation period ends. If you should die, your account balance up to $10,000 as of the date of death will be cancelled. There are eligibility requirements, conditions, and exclusions that could prevent you from receiving benefits under the Account Protector Program. You may find a complete explanation of the eligibility requirements, conditions, and exclusions in sections 1-7 of the Account Protector Terms and Conditions which will be mailed to you upon enrollment. Not available in all states. The Account Protector Program may be cancelled by you or us at any time. You have 30 days from enrolling to cancel without cost by writing to P.O. Box 25183, Santa Ana, CA 92799-9503. This summary of the Account Protector Program is subject to the Account Protector Terms and Conditions, which you agree to be bound by if you enroll.