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1-866-642-3831

Client Prepaid Card Application Form

Submitted information will be used solely for the intent to provide client with further details of product information, and will not be shared with any third party.

Company Name:*

Address:*

Contact Name:*

Country:*

Title:

City:*

Telephone:*

Zip/Postal Code:*

Mobile:

Email:

Fax:

Brief summary of your business:

Card Services:*

Affiliate Compensation	Employee Incentive
Commission Payment	Loyalty
Gift	Other

Cardholders Demographics
Country:		# of Cardholders:

Country:		# of Cardholders:

Initial cards order:

Average load value:

Will the cards be re-loadable?	YesNo
# of loads per month:

Additional comments:

Upon receipt of the Prepaid Card Application Form, Card One Plus representative will contact you with further details.

Cards are issued by St. Kitts-Nevis-Anguilla National Bank Limited pursuant to a license by MasterCard International Incorporated.
MasterCard is a registered trademark of MasterCard® International Incorporated.