Multi-Currency Cash Passport PDS - Travelex Australia

APPLICATION FORM
Please read the important information below:
Complete in BLOCK LETTERS
Please note that certain information is required for identification
purposes in the event of your Card being lost or stolen.
Title (Mr/Mrs/Ms/Miss):
First Name(s):
Last Name(s):
Residential Address:
Suburb:
Postcode: State:
Home Phone:
Mobile Phone:
Email:
Date of Birth:
Mother’s Maiden Name:
Important Information
Personal Information is collected for the purposes relating to providing the product
and/or service requested. By successfully applying for a Multi-currency
Cash Passport Card, you are consenting to us using your personal information to
notify you of our related products, promotions and customer surveys that we may
conduct from time to time. If you have any privacy concerns, please contact the
Privacy Officer using the contact details shown at www.cashpassport.com/multi.
By ticking this box I consent to being contacted by email or text message in relation to
Cash Passport functions, features and promotions and our related products,
promotions and customer surveys that we may conduct from time to time.
eStatements: If you provide us with your email address you can opt in to
eStatements by ticking this box. If you opt-in we will no longer send you
paper statements and instead will notify you when your statement is available
to view and download electronically. For more information, please visit
www.cashpassport.com/multi.
Please tick this box if you consent to your Personal Information being passed
to Travelex so that they may contact you about products and services and
promotional offers and discounts from the Travelex group of companies
By accepting and using the Card you agree to be bound by the Terms and Conditions
detailed in this brochure. By signing this application form you will be deemed to have
accepted the Terms and Conditions.
I confirm that I have read, understood and accept the attached Terms and Conditions
Signature
Date
FOR OFFICE USE ONLY
To be completed while the customer is present.
Please indicate if this order is for:
Reloadable new card Reload of an existing card
Card number:
x x x x x x
Secondary Card number:
x x x x x x
Currencies requested for initial load:
Currency Amount in Currency Amount in AU$
24 25
AU$
US$
EU€
GB£
NZ$
HK$
SG$
NOTE: The Currencies available in respect of the Card may vary from time to time and
not all Currencies may be available at all times. Before you make a decision to acquire
the Card, please check with the Distribution Outlet for details of the available Currencies.
Initial card / in-store reload fee (AU$):
Total AU$ amount received:
Photo ID verified by agent:
Drivers Licence Passport
Photo ID number:
Agent Code:
Agent Name:
Town/Suburb:
Consultant Name: