Primary cardholder details
Full name
Enter your full name as it appears on your statement
Date of birth
Account number
This is a 16 digit number and can be found on your statement
Additional cardholder details
Full name
Enter the full name as it appears on your nominated additional cardholder's ID
Email address
Date of birth
Declaration
I hereby apply to Latitude to add the person named on this form as an additional cardholder on my account
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I acknowledge that:<br /><br /> 1. Each use of the additional card will be subject to the credit contract for my account;<br /> 2. I will be liable for any use of the additional card, and any breach of the credit contract by the additional cardholder;<br /> 3. The information provided in this application is true and correct and that no information which is or could be relevant to Latitude granting credit to me has been withheld;
Authority to disclose and maintain
If you would like your additional cardholder to have access to your account information and maintain your account, please select one of the options below.
I give authority to
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<span style="font-size: 10px; line-height: 100%"> <sup>#</sup> Permits authorised person to obtain account information and arrange for payments only.<br /> <sup>^</sup> Permits authorised person to: obtain account information, act on my behalf including to negotiate with Latitude and make legally binding decisions regarding the account, and undertake the additional activities listed in item 3.<br /><br /></span>
<span style="font-size: 10px; line-height: 100%"> In accordance with section 21T of the Privacy Act 1988, I authorise:<br /><br /> 1. The person nominated on this form as an additional cardholder to request access to my personal information (including credit eligibility information) concerning my account; and<br /> 2. Latitude to act on such request and to disclose to, and if option 2 is ticked to receive from, the nominated person such information related to my account.<br /> <strong>And if option 2 is ticked:</strong><br /> 3. The person nominated on this form as an additional cardholder to maintain my account including to:<br /> a) Make a change of address and phone numbers;<br /> b) Request the issue of a new card or activate a card on my account;<br /> c) Request changes to special promotion details, if incorrect; and<br /> d) Request fee/charge reversal, if the details are incorrect.</span>
<span style="font-size: 10px; line-height: 100%">This authority remains in force until I cancel it. I understand that I may cancel this authority at any time by written notification to Latitude with the termination being effective from the date written notification is received by Latitude.</span>
Privacy acknowledgement
I have read and agree to the <a href="https://www.latitudefinancial.com.au/privacy/" target="_blank">Privacy Policy</a>.
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Thank you for nominating to be an additional cardholder on your GO MasterCard account. Your request has been submitted.

An email will be sent to your nominated additional cardholder requesting them to confirm their ID, once confirmed their new card will be sent to you at your registered address.

GO MasterCard