• AxisPlus Card Enrollment Agreement

    Thank you for electing an FSA with AxisPlus Benefits. Please complete the information below to elect up to two AxisPlus Debit Cards that will be sent to you via mail.

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  • Date Format: MM slash DD slash YYYY
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  • As a participant in one or more of your Employer’s Plans or as an account holder under the AxisPlus Benefits™ program, you will receive an AxisPlus® Visa® Debit Card and agree to use it according to this Agreement and the Cardholder Agreement that will be provided to you with the Card.

    You understand that the Card is restricted to certain merchant categories and is not accepted at all Visa® acceptance locations. You understand that you may not obtain a cash advance with the Card at any merchant, bank or ATM. You understand that the Card is to be used exclusively for Qualified Expenses as defined by the plan(s) in which you participate. If the Card is issued pursuant to Employer Plans and you use the Card for an expense that is not a Qualified Expense, you are indebted to your employer and must repay the full amount of the non-qualified expense.

    You agree to save all invoices and receipts related to any expense paid with the Card; upon request you must submit these documents for review by the Plan Service Provider. Failure to submit the receipt(s) will cause the expense to be treated as a non-qualified expense and you will be required to remit payment to your employer. Payment may be in the form of an offsetting claim, a personal check, electronic draft from your personal checking or savings account, a post-tax deduction from your paycheck, or other options established by your employer.

    Please Note: Additional terms and conditions are outlined in the Cardholder Agreement enclosed with the Card.



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