MilesAway Express Request

Please fill in the information below. Information marked with a * is required to submit your request. When finished, click the "Submit Request" button at the bottom of the page.

Please tell us about yourself.
  • (as xxx-xx-xxxx)
  • (as mm/dd/yyyy)
  • (This Program is not available in Puerto Rico, Guam or Virgin Islands.)
 
  • (as xxx-xxx-xxxx)
Please tell us about your practice.
 
  • (as xxx-xxx-xxxx)
  • (as xxx-xxx-xxxx)
  •  
  • Your e-mail address will never be sold. It will be used to send you important notices.
years
years
Please provide us with some financial information.
$
Please show us how you would like your card imprinted.
Name and title (designation) and/or clinic name as you would like it imprinted on your card. Your full name and practice name cannot exceed 21 characters per line, including spaces. Please spell your last name completely.
  • Doctor's Name, e.g., John Henry Smith
  • (Optional) Practice Name, e.g., Smith Clinic
Authorization and Disclosure

By submitting this request, I certify that I have read, met and agreed to all of the terms, conditions and disclosures below.

IMPORTANT INFORMATION REGARDING YOUR APPLICATION

MilesAway MasterCard Terms, Conditions and Disclosures

Annual Fee

NONE

Periodic Rate of Finance Charge

The Monthly Periodic Rate of Finance Charge on portions of your Account will be determined in accordance with a variable rate plan. Introductory Rates may be used from time to time. Purchases on your Account are charged a variable ANNUAL PERCENTAGE RATE (“Variable APR”). The “Periodic Rate” for any given billing cycle shall be calculated in accordance with the following formula: (Annual Percentage Rate/365) x (Number of days in billing cycle) = Periodic Rate. For complete details on the Periodic Rate of Finance Charge click here.

Grace Period on Purchases

25 calendar days.

Minimum Finance Charge

$.50

Transaction Fees

Cash Advance - 3% of the transaction amount (minimum $10).
Over the Credit Limit Fee - $25.
Dishonored Payment Fee - $25 (except in Maryland).
Late Payment Fee - $25.
Alternative Payment Method - $10 for any payment you make via the Automated Response Unit. $15 fee for phone payment with a customer service representative.
Balance Transfer Fee - 3% of the amount of the Balance Transfer (minimum $10, maximum $75).

Note: These terms and conditions are current as of September 2013. If you have any questions, please call 1-800-503-0954, option 2 for assistance.

By signing the application, I (1) request that NCMIC Finance Corporation (herein “you” or “your”), the card issuer, establish a MilesAway business card account for my Company and issue one or more cards to be used in connection with the account; (2) authorize you or your designees to investigate my Company’s creditworthiness by obtaining reports from credit reporting agencies and other information and credit records, and to share such information and information regarding the account with credit reporting agencies, other creditors of my Company, and third parties that you reasonably believe are conducting credit inquiries in accordance with applicable law; (3) authorize my Company’s past and present lenders, lessors, landlords and other creditors to provide you or your designees with any and all information that will assist you in your credit inquiry; and (4) certify that all information provided in this application is true and correct. I agree that, if an account is opened in response to this application, (5) the account and the card(s) shall be governed by the terms and conditions of the Cardholder Agreement provided to me when the card(s) are issued, as it may be amended from time to time. I agree that any dispute arising under or related to the account or the card(s) shall be adjudicated in the Federal or State Court located in Polk County, Iowa. (6) I am personally responsible for all charges, advances and fees made or incurred under the account by my Company or anyone authorized or permitted by my Company to use the account and/or the card(s); and (7) the Account shall be used only for business or commercial purposes. (8) I understand this application is given for the purpose of obtaining credit and that even if I accept this offer, you may choose not to extend credit to me if you determine I do not continue to meet any applicable criteria bearing on my credit worthiness established prior to my selection, or if I omit any information requested on the Express Request so that you are unable to confirm my identity. (9) I understand that even if you do extend credit to me, the credit line and the terms of my Account will be based on a review of the information I provide in this Express Request, my current consumer report and any other information bearing on my credit worthiness. (10) By signing the Express Request, I agree that you or your designees may obtain consumer reports from credit reporting agencies, and investigate my credit in connection with your credit inquiry and hereby instruct all credit reporting agencies to provide you with such consumer reports upon request.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your drivers license or other identifying documents.

Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with the law concerning this credit is the Federal Trade Commission, Division of Credit Practices, 6th and Pennsylvania Avenue, NW, Washington, D.C. 20580.

Click here to print the terms, conditions and disclaimers

* I have read the Authorization and Disclosure and: