Activate Your Premier Platinum Card

Please complete this secure form to activate your account

Enter your 16 digit account number as it appears on your card *

Company Name *

Contact Name *

Contact Number *

Street Address, Unit #

City, State, Zip

Contact Email

Social Security Number *

Type of Business

% of Ownership

I Plan to *

Activation Code *

YES I AGREE THAT THE INFORMATION I AM SUBMITTING IS TRUE AND CORRECT AND I AGREE WITH THE TERMS IN THE DECLARATION.

* Required

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