FAX またはご郵送でのお申し込みについて

FAX またはご郵送でのお申し込みについて
お申し込み資格
1. アメリカ在住でアメリカの銀行に口座をお持ちの JAL ファミリークラブ本会員の
方に限ります。まだ JAL ファミリークラブに加入されてない場合は、まず JAL フ
ァミリークラブの加入手続きをお済ませいただいてから、当クレジットカードをお
申し込みください。
【JAL ファミリークラブへのお申し込み方法】
オンライン申込み、申込み書のダウンロードは：http://www.ar.jal.com/jalfc
JAL ファミリークラブに関するお問い合せは：
1-800-525-6453
2. 原則 18 歳以上の収入のある方で、米国市民または米国に合法的に滞在できるビザ
をお持ちの方でなければなりません。収入や所属勤務先、住所を証明する書類を提
出していただく場合がございます。
*上記を満たしている場合でも、所定の審査によりカードを発行できない場合がございますので
ご了承ください。
お申込書をお送りいただく前に
1. カード規約を必ずお読みいただき、内容に同意される場合のみお申し込みください。
2. お申込書に記入漏れが無いかご確認ください。
3. 署名欄に署名されているかご確認ください。
4. ソーシャルセキュリティ番号をまだご取得されてない方は、パスポートの顔写真の
写し、及びビザスタンプの写しを添付してください。
送付方法
FAX 番号：
1-800-996-2628 または 949-437-9681
※番号間違いのないようご注意ください。
送付先住所：19800 MacArthur Blvd., Suite 400, Irvine, CA 92612
※ 恐れ入りますが、切手をお貼ってお送りください。
J A Lファミリークラブ・プレミオカード（クレジットカード）入会申込書 / JAL FAMILY CLUB/PREMIO CARD APPLICATION FORM
※ No membership is issued if credit is not approved.
※ You must become a JAL Family Club Member in advance of
※ 審査により入会のご希望に添えない場合もありますのでご了承ください。
※ JALファミリークラブ未入会の方は、お手数ですが事前に入会手続きをお取りください。
JALファミリークラブへのご入会・お問い合わせ： www.ar.jal.com/jalfc または 1-800-525-6453
※ 本会員をご希望の方で米国の国籍をお持ちでない方は、パスポートの写し（氏名、本籍の記載された
ベージおよびビザのページ）を同封の上ご郵送ください。
※ ローマ字、算用数字ではっきりとご記入の上、下記のファックスまたは住所までお送りください。
ファックス：1-800-996-2628 (949-437-9681)
郵送先： PREMIO /19800 MacArthur Blvd., Suite
your credit card application.
For details of JAL Family Club, please contact 1-800-525-6453.
※ Please enclose a copy of your passport and visa bearing the
applicant's photo if you are not a U.S. citizen.
※ Please fillout completely and fax to1-800-996-2628 (949-4379681) or mail to PREMIO /19800 MacArthur Blvd., Suite 400,
Irvine, CA 92612
※ This application form cannot be returned.
400, Irvine, CA 92612
※ 入会申込書のご返送はできませんのでご了承ください。
◆
❏ YES ❏ NO
Would you like to have an additional card ?
家族会員用カードを希望されますか？
◆
※ YES に印を付けた方は、下の
「家族会員用カード申込欄」
にもご記入ください。
Please check (Additional Monthly/Annual fee may be charged. PREMIO will contact at the time of card issuance.)
ご希望のプログラムをお選びください。（別途月会費/年会費等がかかります。ご希望の方にはクレジットカード発行時にプレミオからご連絡いたします。)
❏ Personal Care Service ❏ Car Life Support
パーソナルケアサービス
カーライフサポート
❏ Long distance call plan "KDDI Ichiban TALK" "KDDI dokodemo TALK"
※New member or current member.
長距離電話・国際電話プラン "KDDI 1番 TALK " "KDDIどこでもTALK" ※ 新規入会または既存の会員
PRIMARY MEMBER CARD APPLICATION 本会員用カード申込欄
Full Name
Date of Birth 生年月日 (月/日/年)
お名前
First Name
/
Last Name
Are you a U.S. resident?
米国にお住まいですか？
❏ YES ❏ NO
Mother's Maiden Name 母方の旧姓
/
Social Security Number
Driver's License No. and State
ソーシャルセキュリティ番号
アメリカ運転免許証番号、州の名前
Home Phone ご自宅電話番号
Physical Address in the U.S. (No P.O. Box)
米国内住所 (P.O. Box 以外の住所をご記入ください)
City
Years at Home Address
米国居住年数
Yrs.
Mo.
❏ Own
持家
❏ Rent
State
❏ Other
賃家
Zip
Monthly Mortgage/Rent Payment
その他
月々のローン支払額/月額家賃
$
Previous Address (If at home address less than 2 years, please fill in your previous address.)
上記住所の居住年数が 2年以下の場合、以前の住所をご記入ください。
Employer
Your Position / Title
勤務先名
部署/役職
Years with Employer
勤務年数
Business Phone 勤務先電話番号
Address of Employer
勤務先住所
City
State
Zip
＊If you provide an e-mail address we may use it to contact you about your accounts. We also use your e-mail address to send you information about products and services youmight find useful.
Your e-mail Address*
e -メールアドレス*
＊e-mailアドレスをご登録いただくと、お客さまのアカウントについてのご連絡や、お客さまに有益な商品やサービスの情報をe-mailにてお送りする場合がございます。
Income in the US *
Other Gross Annual Income*
$
米国での年収*
Source of Other Income*
$
他の所得*
その他の収入源*
$
＊Alimony, child support or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation. ＊離婚手当や養育費補助、または別居手当に関しては、本カードの債務弁済に充てるおつもりでなければ開示しなくても結構です。
Institution
Checking Account Number
JAL Family Club Membership Number
金融機関名
および支店名
チェッキング口座番号
JALファミリークラブお得意様番号
PLEASE SIGN THIS AUTHORIZATION 必ずご本人がご署名ください。
By signing to the right, you the applicant(s) authorize us to obtain information to evaluate this application, and upon approval agree to the terms and conditions, which will be mailed
with your cards. You have read and agreed to all the terms, authorizations, and disclosures contained on this form. You represent that in order to obtain the credit requested all
information you supplied to us on the application is true and correct. This Credit Card is issued by First National Bank of Omaha.
右記に署名することにより、貴方は我々がこの申込書を審査するための情報を入手することを許可し、
本カードの送付時に同封される会員規約、規則に同意します。またこの申込用紙に記載されている
全ての規約、規則を確認読解し同意しています。カード申込みのために記載された全ての情報に虚偽
がないことを表明します。このクレジットカードはFirst National Bank of Omaha から発行されます。
ADDITIONAL CARD INFORMATION (18 or older) 家族会員用カード申込欄
Full Name
お名前
First Name
※
Applicant Signature 本会員ご署名
Date
月 /日 /年
ｘ
/
/
家族会員カードをご希望の方のみご記入ください。
（満18才以上の家族会員の方に限ります。）
Date of Birth
Last Name
生年月日
Relationship
Social Security Number
JAL Family Club Membership Number
本会員との続柄
ソーシャルセキュリティ番号
JALファミリークラブお得意様番号（７桁または９桁）
/
/
(月/日/年)
◆ 下欄は、日本語でご記入ください。/ If you have sources of credit in Japan, please fill out below.
本会員のお名前
（姓）
ビザの種類
（名）
フリガナ
（姓）
日本での所属先/会社名 TEL.
（名）
生年月日
扶
年
月
日
年
月
日
年
月
日
年
月
日
フリガナ
日本勤務時の役職
日本のご連絡先
勤務年数本会員との続柄
フリガナ
（姓）
（名）
養
家
族
（姓）
（名）
生年月日
フリガナ
（姓）
（名）
生年月日
ご連絡先住所
〒
TEL.
名
フリガナ
（姓）
（名）
生年月日
JAL Family Club/ Premio MasterCard
IMPORTANT RATE, FEE AND OTHER COST INFORMATION
(SUMMARY OF CREDIT TERMS)
IMPORTANT RATE, FEE AND OTHER COST INFORMATION
(SUMMARY OF CREDIT TERMS)
Annual Percentage Rate (APR) for 1.9% APR fixed for the first 5 billing cycles after your account is opened.† After that,
Purchases
18.49% APR as of 04/01/2007. †*
Other APRs
Balance Transfer APR: 5.90% fixed for the life of the balance on Balance Transfers
made in the first 3 billing cycles after your account is opened. † After that, 18.49%
APR as of 04/01/2007.†*
Cash Advance APR: 24.49% as of 04/01/2007. †*
Penalty Rate APR: up to 32.49% as of 04/01/2007 (see explanation below). †*
Variable Rate Information
The APR for Purchases and Balance Transfers may vary and will be the greater of
13.99% or the Index plus a Margin of 12.49%.* The APR for Cash Advances may
vary and will be the greater of 19.99% or the Index plus a Margin of 18.49%.* The
Penalty Rate may vary and will be the Index plus a Margin of up to 26.49%.*
Grace Period For Repayment of Not less than 20 days from the date of the billing statement on new purchases
Balance for Purchases
(provided you have paid your previous balance in full by the due date).
Method of Computing the Balance Average daily balance (including new purchases).
for Purchases
Annual Fee
$40 the first year; $70 each year after
Minimum Finance Charge
$1.75 (any billing cycle a finance charge is imposed).
Foreign Currency Transaction Fee 3% of the amount of the transaction (after conversion to U.S. Dollars).
for Transactions in Non-U.S.
Currency
Overlimit Fee: $39.
Transaction Fee for Cash Advances: The greater of $15 or 3% of the transaction (the greater of $15 or 5% of the
transaction for certain “Cash Equivalent Transactions”).
Transaction Fee for Balance Transfers: The greater of $10 or 3% of the transaction.
Late Payment Fee: $35 if your New Balance is less than $500; or $39 if your New Balance is equal to or greater than
$500.
†
Your Annual Percentage Rates (including Introductory Rates or Special Offer Rates) may terminate and increase to a Penalty Rate
or a Preferred Rate if you: (1) fail to make a minimum payment to us; (2) exceed your credit limit; or (3) make a payment that is
dishonored for any reason. Factors considered in determining whether a rate increase will occur may include how you have
handled your account with us and current and historical information regarding your credit in general.
*The Index is each month’s highest one-month London Interbank Offered Rate (“LIBOR”) as quoted in the prior month’s The Wall Street
Journal, after increasing any fractional rate for LIBOR to its next highest whole percentage point.
Please Note: Your account will have monthly billing cycles, except that your first billing cycle may be less than one month. All credit terms,
including minimum finance charges, will apply in each billing cycle including the first billing cycle.
You understand that the terms of your account, including APRs, are subject to change. APRs are not guaranteed and they may change to
higher APRs. Fixed APRs may change to variable APRs and vice versa. IMPORTANT NOTICE REGARDING CHANGES IN TERMS. We
reserve the right to unilaterally change the rates, fees, costs, and other terms at any time for any reason in addition to APR
increases that may occur for failure to comply with the terms of your Account.
You agree that payments on your Account may be applied in the order we select. We may allocate payments to balances starting with the
lowest Annual Percentage Rate.
BALANCE TRANSFERS: Balance Transfers are not available to you until after your Account is opened. You authorize us to make one or
more of the balance transfers that you have requested. All balance transfer requests are subject to our approval; we are not liable if we do
not make a requested balance transfer. We reserve the right to make balance transfers in the order we select and to limit the amount of the
balance transfers that we make (this amount may be less than your total credit limit). If you request an amount that we do not approve, we
may process a partial transfer for less than you requested or we may decline the entire request. In addition, transfer requests that are
incomplete, illegible or requested to cash, to yourself or to another account with us or one of our affiliates need not be processed. To protect
your billing dispute rights, do not request a balance transfer of any amount you might dispute with another creditor. Because there may be
delays in the processing of these transactions, continue paying your other creditors the amounts owed for each balance transfer you request,
until you receive a periodic billing statement from those creditors showing that the requested balance transfer has been processed. You may
also call us at 1-800-688-7070 and review your periodic billing statements from us to determine the balance transfers that we have
processed. Balance Transfers are subject to applicable fees and finance charges and do not have the benefit of a grace period.
CREDIT REPORT: By applying for this account you agree that First National Bank of Omaha may obtain credit reports for purposes of
processing your application and for later purposes related to your account such as reviewing, updating and renewing it, increasing the credit
line and collecting. If you request, you will be informed of whether or not a credit report was requested and of the name and address of the
consumer reporting agency that furnished the report. You also authorize First National Bank of Omaha to verify your employment, income and
other relevant information.
The approval of an account and the ongoing extension of credit may be conditioned upon the guarantee of a third party.
NOTICE TO CARDMEMBERS AND AUTHORIZED USERS: We may report information about your account to credit bureaus. Late
payments, missed payments, or other defaults on your account may be reflected in your credit report.
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of
terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that
identifies each person (including business entities) who opens an account.
What this means for you: When you open an account, we will ask for your name, physical address, date of birth, and other information that
will allow us to identify you. We may also ask for other identifying documents. We will let you know if additional information is required.
The JAL Family Club/Premio MasterCard® credit card (the “Program”) is sponsored by Japan Airlines, Prestige International and First
National Bank of Omaha (the “Sponsors”). Credit card accounts are issued by First National Bank of Omaha. Applicants to and
Cardmembers in the Program must reside in the United States. Participants consent to and authorize the Sponsors along with any parties
with whom they contract in order to manage this program, to share information about the Cardmember(s) and his/her account as necessary to
administer the Program.
Married applicants may apply for separate Accounts in their own names.
OHIO RESIDENTS: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers
and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission
administers compliance with this law.
NOTICE TO MARRIED WISCONSIN APPLICANTS: No provision of any marital property agreement, unilateral statement or court decree
adversely affects our interests and/or rights unless, prior to the time the credit is granted or an open-end credit plan is entered into, we are
furnished with a copy of the agreement, statement, or decree, or have actual knowledge of the adverse provision. Married Wisconsin
residents applying for credit separately must furnish name and address of their spouse to First National Bank of Omaha at P.O. Box
3696, Omaha, NE 68172-9936.
CALIFORNIA RESIDENTS: The applicant, if married, may apply for a separate account. After credit approval, each applicant shall have the
right to use this account to the extent of any credit limit set by the creditor and each applicant may be liable for all amounts of credit extended
under this account to each joint applicant.
NEW YORK RESIDENTS may contact the New York State Banking Department to obtain a comparative listing of credit card rates, fees and
grace periods. New York State Banking Department: 1-877-226-5697.
ARBITRATION NOTICE: You understand that any Cardmember Agreement you receive will contain an arbitration provision that may
substantially limit your rights in the event of a dispute, including your right to litigate in court or have a jury trial, discovery and appeal rights,
and the right to participate as a representative or member of a class action. You may request arbitration rules and forms through either or
both of the following arbitration administrators: American Arbitration Association, 800-778-7879; and National Arbitration Forum, 800-4742371. Please review the Cardmember Agreement and its arbitration provision carefully before you use or allow someone else to use an
account.
Cards are issued by First National Bank of Omaha.
JAL Family Club/Premio MasterCard® Credit Card Rewards Program
TERMS AND CONDITIONS SUMMARY
Please read these terms and conditions for important information about the JAL Family Club/Premio MasterCard® Credit Card Rewards Program (the “Program”).
The Program is sponsored by Japan Airlines International, Prestige International Inc., Prestige International USA, Inc. and First National Bank of Omaha
(collectively, the “Sponsors”). Credit card accounts are issued by First National Bank of Omaha.
1. Program members will earn 1mileage point for each US$1.00 in Qualifying Credit Card Transactions charged on his/her JAL Family Club/Premio MasterCard®
credit card account. “Qualifying Credit Card Transactions” shall mean purchases of goods or services made with your credit card while the account is in good
standing by any authorized user of the account, net of any returns or credits. Qualifying Credit Card Transactions do not include cash advances, balance
transfers, convenience checks, fees of any kind (including late fees, overlimit fees, annual fees, and finance charges), and other non-purchase transactions, or
any Qualifying Credit Card Transactions made at a time when the account is not in good standing. Mileage points will be accumulated in the primary
cardmember’s account, regardless of which authorized user uses the JAL Family Club/Premio Card. As a general rule, mileage points will be accumulated
approximately two billing cycles after card usage and will automatically be added to the JAL Family Club/Premio primary cardmember’s account.
2. In addition to the mileage points described in paragraph 1 above, the Sponsors may also award you one or more additional bonus mileage points, at the
Sponsors’ sole discretion, in connection with certain transactions and/or promotions. Bonus mileage points for enrollment, if any, will be awarded by the end of
the following billing cycle after your first purchase with the card.
3. There is no limit on the number of mileage points you can earn. Mileage points will only be valid until December 31st of the second calendar year after the date
of the Qualifying Credit Card Transaction. If you do not use your mileage points during such redemption period, the mileage points will expire. If you have
mileage points expiring at the end of any year, you must submit an award request postmarked by December 31st of that year to avoid expiration of such mileage
points.
4. If you close your JAL Family Club/Premio MasterCard credit card account before your billing cycle ends, mileage points accumulated will be forfeited.
5. As long as you maintain your JAL Family Club/Premio MasterCard® credit card account, your JAL Family Club membership will be renewed automatically and
the JAL Family Club annual membership fee (US$30) will be charged automatically to your JAL Family Club/ Premio Card. In the event that the primary
cardmember ceases to be a member of JAL Family Club due to membership termination or relocation, please notify Prestige International USA, Inc. dba Premio
to have your account terminated and to avoid additional annual fee(s).
6. Eligibility in the Program is restricted to JAL Family Club/Premio MasterCard® cardmembers whose accounts are in good standing (as defined by First National
Bank of Omaha from time to time). The primary JAL Family Club/Premio Card applicant must be a JAL Family Club Primary Member who resides within the
U.S. and has a checking account. Examples of an account not in good standing include, but are not limited to, an overlimit account, a delinquent account, or an
account otherwise in violation of the cardmember agreement. If your account is open and in good standing, you may earn and redeem accumulated mileage
points. If you fail to pay your account on time or otherwise fail to follow the terms of your cardmember agreement, you will forfeit accumulated points.
7. The Program is offered at the Sponsors’ sole discretion. The Sponsors may, from time to time and in their sole discretion, change or limit any aspect of the
Program and its rules, restrictions, benefits or features, in whole or in part, including but not limited to suspending or terminating all or part of the Program, with
or without prior notice to you. The Sponsors also reserve the right to add any Program membership or other fees or increase such fees, if any.
8. The Sponsors reserve the right to terminate the Program at any time. The Sponsors decisions regarding the Program are final. If the Program is terminated,
you will be notified of the date by which you must redeem all your accumulated JAL Family Club/Premio MasterCard mileage points.. Closing your account (by
you or by the Sponsors) will result in termination of your enrollment in the Program.
9. Any liability for federal, state, or local income taxes or fees or charges arising from the acquisition or use of mileage points or credits is the sole responsibility of
the Program members and not the Sponsors.
10. Every effort has been made to ensure that all information in all Program materials is accurate. The Sponsors are not responsible for printing errors or
omissions.
11. The terms and conditions regarding obtaining benefits from this Program are the same as those outlined in Japan Airlines International’s current "JAL Mileage
Bank" and "JAL Family Club" programs. If you are already a regular Premio cardholder, you cannot use that card to obtain JAL Family Club/Premio Card
mileage points.
12. The Program is void where prohibited by law. Japan Airlines is solely responsible for the rules and administration of the mileage points redemption program.
The Sponsors reserve the right to cancel, modify, restrict, or terminate the Program, or any aspects or features of the Program, including mileage point accrual,
at any time without prior notice to Program members. First National Bank of Omaha is not liable for any accident, loss, injury, or damage incurred in connection
with the cardmember’s participation in the Program. Program members consent to and authorize the Sponsors along with any parties with whom they contract
in order to manage this Program, to share information about the cardmember(s) and his/her account as necessary to administer the Program. The JAL Family
Club/Premio Card is a MasterCard® marketed by Japan Airlines International and Prestige International USA, Inc. dba Premio, under the issuance of First
National Bank of Omaha. With the exception of the mileage points redemption program which is administered by Japan Airlines International, all other services
are provided by Prestige International USA, Inc. dba Premio and First National Bank of Omaha. The JAL Family Club/Premio Card is separate and distinct from
the "JALCARD".
Consent to Receive Disclosures Electronically
By submitting this application, you have demonstrated your ability to access the information on these web pages and have consented to receiving
consumer credit disclosures related to this application electronically. Your consent applies only to the related disclosures and does not apply to
subsequent disclosures, such as changes in terms or periodic statements. You understand that you have the right, at no additional charge, to
withdraw your consent, and/or request a paper copy of the consumer credit disclosures, within thirty days of submitting your application by writing to
First National Bank of Omaha, P.O. Box 3696, Omaha, Nebraska 68172-9936. If you applied, please include a description of the product applied for.
If you have already opened your account, please include your account number. Your application will be processed based on your initial consent, and
the withdrawal of your consent will not affect the processing of your application.
Hardware/Software Requirements

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