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Please fill in the application in English
By submitting this application, the Cardholder authorizes the Bank to issue a card of the same payment system and of the same type attached to his/her card account and to provide the additional card to the person designated in this application. The holder of the attached card will be authorized to use funds available on the card account within limits specified in this application. Both the main Cardholder and the holder of the attached card must be present at the Bank and supply valid personal identification documents to receive the attached card.
Fields marked with * are mandatory
Your main card*
Branch*

Mention the branch where you have ordered

Main Cardholder details

First name*
Last name*
Passport*
Phone number*
Card number*
E-mail*

Attached card holder details

First name*
Last name*
Patronymic name*
Passport*
Social services number*
Phone number*
Attached card limit*
Specify limit amount*

Residency details

Residency*
Specify state of residency
I confirm that I have read and accept “ACBA-CREDIT AGRICOLE BANK” CJSC’s “Terms and conditions for issuing and servicing payment cards” and card issuing and servicing fees, and that the information provided in this application is complete and accurate. I confirm that I am familiar with the possible risks regarding the usage of payment cards presented in the “Advices for cardholders” section in the website and the advice regarding the process of following the safty rules.*
Written on the picture   
In case of any inconsistencies between the published Armenian and English information, the Armenian version prevails.
Updated: 04.08.2015 17:35
82-84 Aram Street, Yerevan, Armenia
Tel: (+374 10) 31 88 88
Fax: (+374 10) 54 34 85
E-mail: acba@acba.am