To apply for the AMSA Student Gold Credit Card,
simply complete and return this form
Your application checklist
SECTION 2 – YOUR HOME DETAILS
Stable non-semester Address. (Please do not provide a PO Box.)
Your Residential Status: Own Mortgage Rent Living with Parents
If less than 5 years, what was your previous address? (Please do not provide a PO Box.)
How long have you lived at your current address? Y Y
Office use only
PLEASE SIGN – BASIC APPLICANT
Please ensure that the application is only sent once.
Once your application has been submitted, you will hear back from us within 10 days.
Signature of Applicant
Date of Signature
By signing below, I acknowledge that I have read and agreed to the Declaration overleaf.
I acknowledge that I have a good credit history.
SECTION 3 – YOUR EMPLOYMENT DETAILS
Nature of Business (e.g. Legal)
Name of Employer or Name of Your Business
Time with Employer Years Months
Business Address, street name
Accountant's Name (if self-employed).
We need this to verify your employment details. By providing this information, you are agreeing for your
accountant to give your details to American Express.
Your Employment Status
Employed Self-employed Retired
Your annual salary before tax $
(Must be over $8,000 p.a.
SECTION 4 – YOUR CONTACT DETAILS
Home Telephone No.
Mobile Telephone No.
Please tick if you would like to receive an email notification to view your statement online and not
receive your statement by mail.
If you wish to receive changes to Product Terms and Conditions, marketing and other communications
from us from time to time via email, please provide your email address.
Your Occupation (e.g. Accountant)
SECTION 1 –