APPLICATION FORM FOR APIOS A-CARD CARD
1. GENERAL DATA ON THE COMPANY OR CRAFT:
*if you have more than one giro account, please list others under “Other notes”
2. DATA ON THE EXPECTED USE OF THE A-CARD CARDS/ FLEET STRUCTURE:
Total number of:
- Purchase category 1 - enables the purchase of diesel fuel
- Purchase category 2 - enables the purchase of all fuels and the purchase of vignettes and supplements for toll fee payments/li>
- Purchase category 3 - enables the same range of services as category 2 with the possibility of using the car wash, washer fluids and distilled water, oils and lubricants, antifreeze, car cosmetics and car parts
- Purchase category 4 - enables the purchase of a full range of products at petrol stations, except mobile phone coupons
- Purchase category 5 - enables the purchase of a full range of products at petrol stations
- By selecting the odometer option, at every use of the A-CARD card, the mileage will have to be entered at the petrol station
- In accordance with Article 5.4. of the General Terms and Conditions for the use of the A-CARD card, security limits as the restriction of the daily or monthly allowed amount and/or number of purchases with A-CARD cards are defined for each A-CARD card. If the User does not agree with the security limit estimation, he/she is obliged to contact the Issuer of the A-CARD card in writing and request that the limit be changed.
Under material and criminal liability, we confirm the truthfulness of all the data stated in the Application and we state that we are familiar with the General Terms and Conditions for the use of the A-CARD card, are we accept them in their entirety. We declare that we will fully and in a timely manner fulfill all our obligations arising from the use the A-CARD cards.
By signing the A-CARD cards Application form, we authorize the Issuer of the A-CARD card to verify all of the above data and to request and collect additional data and documents if necessary. For the cards ordered for a specific user/ name and surname of a person, the Issuer of the A-CARD cards retains the right to request additional information on such user, such as the PIN, job position, business information, bank clerk etc.
We agree that the A-CARD card Issuer be authorized to reject this Application form without any justification.
(INCOMPLETE DOCUMENTATION WILL NOT BE TAKEN INTO ACCOUNT FOR FURTHER CONSIDERATION)
I) Payment insurance instruments (in accordance with its own assessment, Apios will inform the applicant on the payment insurance instrument he/she/it must submit when concluding the contract).
Payment security instruments for all obligations, costs and other claims of APIOS d.o.o. towards the buyer and/or card user are the following:
- Promissory note with the personal guarantee of the responsible person and/or the owner of the buyer (It is mandatory to fill in all columns to be filled in by the debtor in accordance with the data on the blank promissory note: 1,2,5,7. Under 1, in accordance with previous agreement and the instruction on the promissory note, the amount has to be filled in, under 5, “All my accounts with all legal entities performing payment transactions” if not printed
has to be entered. The signature has to be certified by a notary public.)
- Bank guarantee without objection, payable at first demand
- Bill of exchange without protest
- Bill of exchange with guarantee without protest
- Real estate lien
- Third party guarantee
- Fiduciary ownership transfer
Apios retains the right to request the issuance of additional payment insurance instruments during the duration of the Contract on the use of the A-CARD, which the buyer has to submit without objection.
In the event of the rejection of the above, APIOS retains the right to terminate the Contract at the expense of the buyer, and suspends his/her/its use of the A-Card.
II) Additional appendices:
Crafts and liberal professions:
For all questions or help regarding fulfilment of the Application forms please be free to contact A-CARD department on 0800 5771 or firstname.lastname@example.org.