C O R P O R A T E   C A R D      

EMPLOYEE APPLICANT INFORMATION

Please print or type:

First Name			Middle Initial			Last name

				      /      /				
Social Security Number		Date of Birth			

Preferred Billing Address:  Home _X___

Home Address - street

City				State 				Zip

(         )				(         )
Home Phone			Business Phone			Employee Number (If Applicable)

Place of Employment (Department)

COMPANY INFORMATION 

This section to be completed by authorized Company Program Administrator:

Name of Company Requesting Issuance of Card

Address of Company – Street			City 		State	Zip

Processing:  _ _   _   _  _    											
          Company		       Division 		      Department 

Reporting/FirstTracSM:  _ _ _ _ _   _ _ _ _ _   _ _ _ _ _   _ _ _ _ _   _ _ _ _ _   _ _ _ _ _   _ _ _ _ _

Company Program Administrator Signature  __________________________________________________

EMPLOYEE UNDERSTANDING / SIGNATURE 

Employee Applicant requests that he/she be issued a U.S. Bank Visa Corporate Card.  U.S. Bank may obtain credit information concerning Employee Applicant for the sole purpose of issuance, renewal and/or replacement of the U.S. Bank Corporate Card.  In consideration of this issuance and the use of the U.S. Bank Corporate Card, the Employee Applicant agrees to be bound by the U.S. Bank Corporate Cardholder Agreement accompanying the card, as amended by U.S. Bank from time to time, for all charges incurred by the use of the card or the related account.  Creditor is U.S. Bank National Association ND.

Employee Applicant understands that this card is to be used for business charges only and that Employee Applicant is totally responsible and liable for all expenses charged to the card.  Employee Applicant understands and acknowledges that payment is due to U.S. Bank upon receipt of the statement.  Employee Applicant further understands that if he/she fails to pay U.S. Bank for all undisputed charges his/her card will be permanently canceled.

	___________________________________		___________________________________
	Employee Applicant Signature/Date			Approving Manager Signature/Date

Your U.S. Bank Visa Corporate Card will be mailed to you within 7-10 days following the receipt of you application.  Unless otherwise instructed, please return this application to your designated Company Program Administrator.  Thank you.