Accept my invitation to Membership in the Bankers Club. This day of, Signature of Membership Candidate

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Nickolas Mills
8 years ago
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1 I, Accept my invitation to Membership in the Bankers Club This day of, 2013 Signature of Membership Candidate Initiation Fee/NonTransferable 1

2 CANDIDATE INFORMATION ο Mr. ο Mrs. ο Ms. ο Miss ο Dr. Name Date of Birth Home Address Home: Phone Fax Marital Status: ο Single ο Married Wedding Anniversary Date Social Security # Driver s License # State Company Name Type of Business Title Length of Employment (years) Business Address Business: Phone Fax I prefer internet mail be sent to my ο Home ο Business SPOUSE INFORMATION ο Mr. ο Mrs. ο Ms. ο Dr. Spouse Name Date of Birth Social Security # Driver s License # State Company Name Type of Business Title Length of Employment (years) Business Address Business: Phone Fax I prefer internet mail be sent to my ο Home ο Business DEPENDENT INFORMATION [A Dependent is an unmarried child under 21 (or under 23 attending college) residing with Candidate] Name(s) Date of Birth Charge Privileges Initiation Fee/NonTransferable 2

Length of Employment (years) Business Address Business: Phone Fax E-mail I prefer internet mail be sent to my ο Home ο Business SPOUSE INFORMATION ο Mr. ο Mrs. ο Ms. ο Dr.

3 REFERENCES Our Member sponsor is: Co-sponsor (if applicable): Phone Phone Other personal references (can be non-member): I/We am/are applying for Membership in the following category: MEMBERSHIP INFORMATION ** Initiation Fee WAIVED Current Monthly Dues $ ** Initiation Fee non-refundable Application and Processing Fee $ PAYMENT OF MEMBERSHIP ACCOUNT I/We would prefer monthly statements to be mailed to: ο Home ο Candidate s Business Payment of Membership Account, including all dues, fees and other applicable charges, is due upon receipt of the monthly statement. If accepted for membership, Candidate agrees to pay the account in full when due. Candidate agrees and understands that a late charge up to the maximum amount allowable by law, or other penalties, may be assessed for past-due accounts as provided for in the Bylaws and Rules and Regulations of the Club, as amended from time to time. In addition to late fees, penalties may include, but are not limited to suspension of Club privileges and/or expulsion from membership. Candidate further agrees to maintain a major credit card account in Candidate's name on file with the Club at all times. In the event that Candidate's account becomes more than thirty (30) days past due, Club shall have the right to bill such past due amount to Candidate's credit card. By signing below, Candidate agrees to and fully authorizes all such charges to credit card account(s) listed below. Payments on delinquent accounts apply first to reduce late charges and accrued dues, then to food and beverage charges, then to any other charges. Any fees assessed for untimely payment of any applicable dues, fees or charges will appear on Candidate's statement, including any charges made to Candidate's credit card for payment of same. Candidate agrees to pay all reasonable attorneys' fees, investigator fees, and costs in the event this account is turned over for collection. Credit Card Issuer: Credit Card Issuer: Cardholder Name: Cardholder Name: Card Number: Exp. Date: Card Number: Exp. date: Please charge my outstanding balance to my credit card on a monthly basis. MEMBERSHIP POLICIES If accepted into membership, I/we agree to conform to and be bound by the enrollment terms contained herein, the Bylaws, the Rules and Regulations, and written membership policies of the Club ( Membership Documents ) as they may be amended from time to time. I/We further understand that agreeing to be bound by the Membership Documents is a part of my/our agreement for membership privileges with the Club. I/We specifically understand this membership is not divisible. I/We hereby acknowledge receipt of a copy of the Bylaws and the Rules and Regulations of the Club. It is agreed that Applicants may resign from the Club by giving written notice to the Club. The effective date of the resignation will be 45 days from the date the Club receives Applicant's written notice. All accrued dues and other charges for which the Applicant is liable are due upon the effective date of resignation I/WE ACKNOWLEDGE THE MEMBERSHIP BYLAWS AND THE RULES AND REGULATIONS PROVIDE THE DETAILS OF THE CLUB S MEMBERSHIP POLICIES, CONDUCT AND OBLIGATIONS, INCLUDING, BUT NOT LIMITED TO, PROVISIONS IN THE EVENT OF DIVORCE, FOR ARBITRATION OF DISPUTES, RESIGNATION, REDEMPTION OF MEMBERSHIPS, FINANCIAL OBLIGATIONS, DISCIPLINARY ACTION, RELEASE OF LIABILITY FOR PERSONAL INJURY AND THEFT. Initiation Fee/NonTransferable 3

00 PAYMENT OF MEMBERSHIP ACCOUNT I/We would prefer monthly statements to be mailed to: ο Home ο Candidate s Business Payment of Membership Account, including all dues, fees and other applicable

4 I/We agree the terms and conditions of my/our membership may not be added to, amended, or contradicted in any way by evidence of prior, contemporaneous, or subsequent oral agreements of any kind and acknowledge there are no unwritten oral agreements of any kind. I/We authorize Club to check my/our credit and employment history and to obtain such information as Club deems necessary to {accept my/our application and to} extend credit to me/us under my/our membership account at the Club. Candidate s Signature Date Spouse s Signature Date FOR CLUB USE ONLY Accepted On: By: Copy of this contract returned to Candidate on Chrono Number Member Number Initiation Fee $ Title: By: Activity Code: Type Code: Date Received: Initiation Fee/NonTransferable 4

I/We authorize Club to check my/our credit and employment history and to obtain such information as Club deems necessary to {accept my/our application and to} extend credit to me/us under

5 The Bankers Club accepts all major Credit Cards CREDIT CARD AUTHORIZATION Yes. Please bill the balance due to the credit card listed below. VISA MASTER CARD AMERICAN EXPRESS DISCOVER Account Number Exp. Date CV# (Visa/MC-last 3 digits of number on back of card; Amex-4 digits above logo) Name Company Billing Address Billing City, State, Zip code Day time Telephone Number Signature DATE / / Please Fax to The Bankers Club, One Biscayne Tower, Suite 1400, Miami, FL (305)

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