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Priority PassTM enrollment form for the Basic American Express ® Platinum Reserve Credit Cardmember

Basic American Express® Platinum Reserve Credit Cardmember's Personal Details

Card Expiry Date:

I instruct Priority Pass Ltd. to charge lounge usage fees for myself and all my accompanying guests, at the prevailing rate (currently US$32 per person per visit) to my American Express Platinum ReserveSM Credit Card. I agree to abide by the Conditions of Use as contained in the Lounge Listing.

I agree that American Express® may transmit to Priority Pass information necessary for the creation, dispatch and operation of the Priority Pass Card. This information will be what you have already provided to American Express as part of your application for an American Express Card.

Terms and Conditions

The Priority Pass Offeris open to all American Express Platinum ReserveSM Credit Card ("Cardmembers") whose accounts are valid and in good standing • Every visit would be charged as per the prevailing rates; currently US$32 per person • Any accompanying guests will be charged US$32 per visit, which will be automatically charged on the Cardmember's American Express Platinum ReserveSM Credit Card. Renewal terms and conditions are at the discretion of Priority Pass Ltd. • Any such participation is voluntary and the offer is being made purely on a best effort basis • These terms have to be read along with the Conditions of Use mentioned below • Any disputes arising out of this programme shall be subject to the exclusive jurisdiction of the courts in the state of Delhi.

Conditions of Use