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d User requests any VISA Business Card services, Holder or Authorized User consents to the release of Holders or Ainhorized User's personal data to VISA USA, Inc. and its member financial institutions and/or their respective contractors for the purposes of providing such services. 2. Membership Fees. A nonre

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d User requests any VISA Business Card services, Holder or Authorized User consents to the releaSe of Holder's or Authorized Users personal data to VISA USA, Inc. and its member financial institutions anclior their respective contractors for the purposes of providing such services. 2. Membership Fees. A nonr

ITY: STATE: ZIP CODE: YEARS AT ADDRESS OWNERSHIP STATUS: TIOWN FIRENT MOTHER: POSITION WITH COMPANY: 3 PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? nYES nNo VISA BUSINESS OR CORPORATE CARD? nYES nNo MASTERCARD BUSINESS OR CORPORATE CARD? OYES ONO MONTHLY MO