fullmaktsskjema / signature on file (sof) - American Express Global ...

Herved gir jeg American Express Corporate Travel AS
fullmakt til å belaste mitt kredittkort for reisetjenester
bestilt av meg selv eller nedenfor nevnte personer.
Avtalen er inngått med American Express
Corporate Travel AS sentralt og gjelder for alle
American Express byråer/avdelinger i Norge.
Jeg er klar over at denne fullmakt har en gyldighet
som tilsvarer kortets gyldighetstid. Dersom
fullmakten ønskes opprettet etter kortets utløpsdato,
må beskjed gis til det lokale American Express
byrået.
Engangsfullmakt / Single authorisation:
Kryss her dersom fullmakten kun skal gjelde for 1 bestilling / please
make a mark if this is an authorisation for single use only:
FULLMAKTSSKJEMA / SIGNATURE ON FILE (SOF)
I hereby give American Express Corporate Travel AS the
right to charge my credit card account for travel services
ordered by myself or the delegated persons stated
below.
The agreement with American Express Corporate
Travel AS is valid for all given American Express travel
agencies/ departments in Norway.
I am fully aware that this authorisation is valid for
the same duration as my credit card. If I wish to
extend the authorisation after this initial period,
instructions must be given to the local American
Express travel agent.
PERSONLIG / PERSONAL DETAILS
Kortinnehavers navn / Card holders name :
Adresse / Address :
Postnr. / Post-office box. :
Sted / Town :
Ansatt i firma / Employed by:
KORTSELSKAP / CREDIT CARD COMPANY
Kortselskapets navn / Credit card company :
Kortnummer / Credit card number :
Utløpsdato / Expiry date :
HAR FULLMAKT Å BENYTTE - SOF / AUTHORITY TO USE SOF
Navn / Name :
Navn / Name :
SIGNATUR / SIGNATURE
Kortinnehaver / Card holder sign :
Sted / Place :
Dato / Date :

Skjemaet returnes i utfylt stand til :
Return completed form to :
American Express Corporate Travel AS
Postboks 455 Sentrum
0104 OSLO
Telefax: +47 22 98 36 39