The American Express Airpoints Card

General and contact information

1. Date of Birth (DD/MM/YYYY)* Date of birth - box 1 of 3 enter the day you were born on, in the format dd  /  Date of birth - box 2 of 3 enter the month you were born on, in the format mm  /  Date of birth - box 3 of 3 enter the year you were born on, in the format yyyy
2. Are you an existing Air New Zealand Airpoints^TM member?* Yes No
3. If you are not already an Air New Zealand Airpoints programme member, American Express will instruct Air New Zealand to create a new Airpoints membership for you, and link this to your new The American Express Airpoints Card account once approved. By proceeding with your application you accept the Air New Zealand Airpoints Terms and Conditions. These Terms and Conditions may be amended from time to time. More information is contained in the Declaration.
4. Enter your Airpoints Number*
5. Identification and Contact Information
   
   For your security and to meet legal requirements, we need to verify the identity of all Card Members. To assist in this process we require your current Drivers Licence number, home phone number and residential address.
   Please note:
   • Your NZ Drivers Licence No will be verified with the NZTA for confirmation of your identity; and
   • We may use you contact information to contact you regarding your application or to request further information to verify your identity.
6. NZ Driver's Licence NoLicence number (Field 5a) and Version number (Field 5b)   
   Please provide the full details of your drivers licence including the details in field 5B.
7. Marital Status* Select Status Single Married/Defacto Divorced/Separated Widowed
8. Number of Dependants (excluding Spouse)*
9. Highest Level of Education Achieved* Choose One NCEA Level 1 (Formerly School Certificate) NCEA Level 2 (Formerly Sixth Form Certificate) NCEA Level 3 (Formerly University Entrance, Bursary or Scholarship) Diploma Bachelors Degree Masters or Doctorate


11. Phone Details
    
    

Please enter either a valid home phone or mobile telephone number



       Please ensure you have provided either a valid home phone or mobile telephone number.
12. Home Phone NumberArea Code/Phone Number   
    Your home telephone number is required as part of our standard credit checks. Having it will help us to process your application as quickly as possible.
13. Mobile Phone Number
    Your mobile phone number may help us to contact you quickly if we have any questions about your application.
14. American Express requests your e-mail address to send you changes to your product terms and conditions and other important information about your account.
15. Email Address*
    Your email address may help us contact you quickly if we have any questions about your application.
16. Where You Live
17. Residential Street Address*
    Provide your physical address, not a PO Box.
18. Suburb
19. City*
20. Postcode*
    If you don't know your postcode, please visit www.nzpost.co.nz/postcodefinder
21. If you don't know your postcode, please visit Postcode
22. Accommodation* Do you rent or own? - Own Own Outright Do you rent or own? - Other Mortgage Do you rent or own? - Rent Rent Do you rent or own? - Other
    Living With Parents
    
23. How long have you lived at this
    address? (YY/MM)*   /  

Our communications with you

1. Email Communications:

2.    Tick this box if you want American Express to keep you updated via email about your Card benefits, rewards and promotions such as exclusive presales, travel and Bonus Points offers. We will not share your email address with others. For more details on how we will use your information please read our privacy statement    Yes, I would also like to receive marketing communications to the email address I have provided above. I can change my email preferences at any time by visiting www.americanexpress.co.nz
   Please note: If you uncheck this option, you will not receive marketing communications via email.
   Our Privacy Policy Statement outlines how we handle your personal information.
3.    Yes, I would like to receive my statements online and be notified by email every month when my statement is ready to view online.
   Please note: The Online Statement will be an exact replica of a paper statement. You can download, save and print the statement and we will keep your recent statements organised and available for you securely online for access at anytime and from anywhere. If you uncheck this box, you will receive your statements in the post to your billing address.
4.    I have read and agree with the Online Statements Terms & Conditions.*

Employment information

1. Your Employment* Select Employment Full Time/Part Time Casual Self Employed Retired Home Duties Unemployed
   We need your employment details to help us with our credit checks. Your privacy is important to us and we will not contact your employer without your written permission.

1. We need some more information about your employment.
2. Occupation* Select One Accountant Administrator Adult Entertainment/Night club worker Cabin Crew Chairman/CEO Clergy Contractor/Consultant Department of Defence, Army, Navy, Airforce Diplomat Drivers Taxi Drivers Truck Educator Engineer Factory worker Government Minister/Politician Hospitality (Restaurant/Hotel) Home Duties Labourer Law Enforcement Legal Profession (Solicitor, Barrister, Judge) Manager Musician/Actor Newspaper Nurse Office Staff Pensioner Pilot Professional (Doctor, Dentist, Vet, Pharmacist, Architect) Sales/Commission Work Service Worker (Postal, Electrical etc) Supervisor/Team Leader System Analyst/Programmer Trades Worker (Plumber, Technician) Unemployed Others
3. Industry* Select One Travel Finance Government Legal Medical Construction Import/Export Investment Manufacturing Transport Real Estate Hospitality Education Retail Retiree Professional General Service Motor Mechanic, Electrical, Plumbing Agriculture Telecommunications Media Computers/Electronics Natural Resources Printing/Publishing Other
4. Name of Employer*
5. Employer Street Address*
6. Suburb
7. City*
8. Postcode* For the building you work in
   If you don't know your postcode, please visit www.nzpost.co.nz/postcodefinder
9. If you don't know your postcode, please visit Postcode
10. Employer Phone Number*Area Code/Phone Number   
11. Time at above employer (YY/MM)*  /