ING Corporate Card Programme

To be completed by the Programme Administrator (for example, someone from the accounts department)

1. Surname and initials
2. Gender
   1. Male
   2. Female
3. Date of birth
   dd-mm-yyyy
4. Mobile number (incl. country code)
   Mandatory. The application will not be processed if no mobile phone number is provided
5. Landline (incl. country code)
6. E-mail address, work
   Mandatory. The application will not be processed if no e-mail address is provided. The login credentials for the ING Commercial Card portal will be send to this e-mail address. No email address from a colleague or a general email address such as info@, admin@, etc.
7. Password
   We will ask for your password whenever you call us. Your password should have no more than 12 characters
8. Date
   dd-mm-yyyy
9. Town/City
10. Signature
     
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To be completed by the second Programme Administrator (strongly advised)

1. Surname and initials
2. Gender
   1. Male
   2. Female
3. Date of birth
   dd-mm-yyyy
4. Mobile number (incl. country code)
   Mandatory. The application will not be processed if no mobile phone number is provided
5. Landline (incl. country code)
6. E-mail address, work
   Mandatory. The application will not be processed if no e-mail address is provided. The login credentials for the ING Commercial Card portal will be send to this e-mail address. No email address from a colleague or a general email address such as info@, admin@, etc.
7. Password
   We will ask for your password whenever you call us. Your password should have no more than 12 characters
8. Date
   dd-mm-yyyy
9. Town/City
10. Signature
     
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1. Choose payment method
   1. Credit transfer
   2. Direct debit
2. In case of direct debit, please send a completed and duly signed direct debit form with this form. Direct debit is not possible in USD
3. On which day of the month would you like ING to produce your statements?
   1. around the 2nd
   2. around the 9th
   3. around the 17th
   4. around the 26th
4. From the selected date, a payment term of 10 days applies to a program based on Corporate Pay irrespective of the selected payment method
5. Account name
6. Country in which the bank account is held
   1. Netherlands (EUR)
   2. Belgium (EUR)
   3. France (EUR)
   4. Germany (EUR)
   5. Spain (EUR)
   6. Great-Britain (GBP)
   7. Italy (EUR)
   8. Luxembourg (EUR)
   9. Bulgaria (EUR)
   10. Austria (EUR)
   11. Ireland (EUR)
   12. Switzerland (CHF)
7. IBAN
   If you opt for direct debit at section 4a, please send a completed and duly signed direct debit form with this form
8. BIC
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1. Monthly company limit
   This amount is the total spending limit for all cards covered by this application in the selected currency
2. Do you wish to impose restrictions on expenditure in certain areas?
   1. No
   2. Yes, computer and telecom branch
   3. Yes, department stores
   4. Yes, jewellery and perfume stores
3. ING cannot guarantee that the transactions will always be blocked
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1. Preferred language of correspondence
   1. Dutch
   2. English
   3. French
   4. German
   5. Spanish
   6. Italian
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1. Who should we send the ING Corporate Cards to?
   1. Cardholder
   2. Programme Administrator, name
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1. The company declares that the information provided on this form is true and accurate.
   The company agrees to the ING Corporate Card Terms and Conditions.
   The company agrees to the fees and charges mentioned in the relevant Fees and Charges Brochure insofar as not agreed otherwise in writing.
   The company declares that it established the identity of the Programme Administrator(s) on the basis of a valid identity document
   The company declares that it will submit the personal data of the Cardholder(s) to ING for a client or fraud investigation upon request by ING.
   The company herewith authorises the Programme Administrator(s) to perform for and on behalf of the company all administrative acts with respect to the ING Corporate Card Programme that are necessary to assure the smooth progress of that same programme. Which is also understood to include the increase or decrease of the company limit. This authorisation remains valid until such time that ING receives the applicable form signed by the company stating the withdrawal of said authorisation.

2. Name authorised signatory 1
3. Gender
   1. Male
   2. Female
4. Date of birth
   dd-mm-yyyy
5. Position
6. Date
   dd-mm-yyyy
7. Town/City
8. Signature authorised signatory
    
9. Name authorised signatory 2
10. Gender
    1. Male
    2. Female
11. Date of birth
    dd-mm-yyyy
12. Position
13. Date
    dd-mm-yyyy
14. Town/City
15. Signature authorised signatory 2
     
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1. Checklist of items to be sent:
   - This form completed and duly signed
   - If you have chosen for the direct debit payment option, a direct debit form completed and duly signed
   
   Please send all items to:
   ING Corporate Card
   PO Box 22005
   NL-8900 KA Leeuwarden
   The Netherlands
   or scan everything and mail to support.corporate.card@ing.nl.

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