Individual Cardholder Request Form

Full Name*

Email Address (used on the application)*

Phone*

Billing Zip Code*

I'd like to:*

Designate the charity I support (new Charity Charge Individual cardholder)Change the charity I support with my cash back donationsFind out which charity my donations are currently supportingRequest a summary of donations for the previous calendar year for my taxesFind out how much cash back I earned in the previous quarterMake another request