Professional Documents
Culture Documents
A N R I T S U
S R L
2. Business address
S T R .
1 0
S O L U T I O N S
P I A T A
W T C B
R o o m
MO N T R E A L
B u i l d i n g
E n t
2 . 1 3
Postcode
0 1 1 4 6 9
3. If you are already an existing customer please also provide your company
account number
(as shown on the top of your Barclaycard Commercial monthly statement)
Business address
6. Type of card
Please tick the card type required
Gold
Platinum
7. Cash withdrawals
Do you want to have access to cash withdrawals via ATMs?
(Please note: Cash withdrawals are subject to your organisations authorisation)
Yes
No
(min 250)
PAN
Declaration
By signing this agreement, you confirm that:
You are duly authorised to enter into this agreement for and on behalf of the organisation
The cardholder is employed by this organisation
The details you have given us are correct
You want us to give the cardholder a company card and PIN for which the cardholder is
eligible and from time to time replace the card with any company card covered by
this agreement.
Input ref
Company No.
Cardholder No.
Date of birth
Signature
Date
Signature
Date
Mr
Mrs
Miss
Ms
Other
Forename(s)
J E A N - MA R I U S
Surname
A N T O N I C A
D1 D
8
Date of birth
M1 M
2
Y1 Y9
Y
8
R O MA N I A N
Security password (between 6-15 characters)
Sex
Male
Female
Home address
S T R .
6 A
G R A L
B L . D 1
D R A G A L I N A
S c . E
Postcode
E t . 2
A p . 6
1 1 5 1 0 0
No.
No.
+ 4 0 7 2 9 1 0 6 0 0 9
Email address
jean-marius.antonica@anritsu.com
Y
4
D D
M M
Y Y Y Y
This information is available in large print, Braille or audio format by calling 0844 822 2111.*
*Calls may be monitored or recorded in order to maintain high levels of security and quality of service. For BT business customers, calls to 0844 822
numbers will cost no more than 5p per minute, minimum call charge 5.9p (current at October 2009). The price on non BT phone lines may be different.
www.barclaycard.co.uk/commercial
Barclaycard is a trading name of Barclays Bank PLC. Barclays Bank PLC is authorised and regulated by the Financial Services Authority.
Registered in England. Registered No. 1026167. Registered Office: 1 Churchill Place, London E14 5HP.
TSYS 9909564. BCD94415APPB53. Updated 11/09. 20319BD.