Request to Add an Authorized User on Credit Card Account

* Indicates Required

Share the convenience of your account by authorizing other user(s) to access you account. Each authorized user will receive his or her personal card and will enjoy full access to your account.

Member Information

Member Name *

Member Number *

Credit Card Number *

Email*

Phone *

Authorized User Information

Name *

Social Security Number *

Second Authorized User

Name *

Social Security Number *

Signature

Member Name (type name)*

Date*

Member Signature*

Clear Signature

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212.869.8926

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Request to Add an Authorized User on Credit Card Account

Member Information

Authorized User Information

Signature

212.869.8926