Application Form Request | Form Completion
Once you have submitted your request and your information has been authenticated you will receive your application form via the fax number you provided. Please complete the section of the form labeled "Application Information" and mail or deliver the application to:
Brenda Winn
Office of Financial Affairs
Station B #356310
APPLICATION TIPS
- You may choose either your home or office for the billing address. If you do choose your office address for billing, also provide your home address as requested.
- Verify your Social Security Number. Your Cost Center Number is not required.
- The American Express card is approved to the applicant based on the applicant's credit history -- not Vanderbilt.
Once your application has been received it will be processed and forward to American Express. When the Corporate Membership Card arrives, you will receive a call with your American Express card pick-up options.
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