Maduro& Curiel's bank AAdvantage® Cards
Maduro& Curiel's bank AAdvantage® Cards
Application for credit card * = required field
     
I am a resident of: I am currently a MCB customer.
Curaçao Yes
Bonaire No
Other    
       
MCB AAdvantage VISA MCB AAdvantage KOMPA LEON**
   
Please take payment from MCB Acct#
My AAdvantage Number (if applicable)
   
Payment conditions: Balance protection program:
Minimum payment 5% Accept
Full payment Decline
   
Requested limit NAF./US$
   
NEAREST RELATIVE NOT LIVING WITH YOU
   
Name:
Phone:
   
PLEASE TELL US ABOUT YOURSELF
   
Mr. Mrs. Miss  
Family name:
First name:
Middle name:
Date of birth: - - dd-mm-yyyy
Present address:
# years at address:
Home phone:
E-mail address:
Do you own a home Single
Do you rent Married
Do you live with parents Living together
I.D.#: (passport/drivers license/sédula)
# of dependents:
   
PLEASE TELL US ABOUT YOUR JOB
(if employed less than 3 years provide also previous employment)
   
Employer's name:
Date in business: - - dd-mm-yyyy
Employer's type of business:
Employer's address:
Your phone number at work:
Your position:
Please indicate your gross monthly income: NAF
Any additional income: NAF
Source of additional income:
Previous employer:
   
PLEASE TELL US ABOUT YOUR BANKING ARRANGEMENTS
   
Current account  
Name of Financial Institution:
Account#:
Balance:
   
Savings account  
Name of Financial Institution:
Account#:
Balance:
   
Time deposit  
Name of Financial Institution:
Account#:
Balance:
   
Automobile or personal loan  
Name of Financial Institution:
Account#:
Balance:
   
Mortgage  
Name of Financial Institution:
Account#:
Balance:
   
Other loans  
Name of Financial Institution:
Account#:
Balance:
   
VISA  
Name of Financial Institution:
Account#:
Balance:
   
MASTERCARD  
Name of Financial Institution:
Account#:
Balance:
   
KOMPA LEON  
Name of Financial Institution:
Account#:
Balance:
   
American Express® Card
American Express® member since:
Name of Financial Institution:
Account#:
Balance:
   
Other credit card  
Name of Financial Institution:
Account#:
Balance:
   
CO-APPLICANT'S DETAILS
   
Mr. Mrs. Miss  
Family name:
First name:
Middle name:
Date of birth: - -
Present address:
# years at:
Home phone:
Do you own home Do you rent
Do you live with parents I.D.#:
   
Employer's name:
Time there (yrs):
Employer's address:
Your phone number at work:
Employer's business:
Your position:
Please indicate your gross monthly income: NAF
Any additional income: NAF
Source of additional income:
   
By completing and signing this application I/we declare that the information given is accurate and is provided in order that Maduro & Curiel’s Bank N.V. may determine if a card should be issued. Failure to provide accurate information may result in the application being declined or credit privileges revoked.

By signing below I (we) are requesting Maduro & Curiel’s Bank N.V. to issue MCB AAdvantage® credit cards are issued and I (we) acknowledge that I (we) will be bound by the terms and conditions that will be sent to me (us) when MCB AAdvantage® credit card is issued. Should I (we) not wish to be bound by the Terms and Conditions, I (we) will cut the unused card in two and return both halves to the Bank.
 

FAX: If you wish to fax this form, please print, sign and fax to our BankCard Services Department at : 466-0700

Signature Applicant:(only for faxed applications)
Date: - - dd-mm-yyyy
 
Signature of Co-Applicant:(only for faxed applications)
Date: - - dd-mm-yyyy