Document:

exv4w1

Exhibit 4.1

AMERICAN EXPRESS ISSUANCE TRUST

OMNIBUS AMENDMENT TO

INDENTURE SUPPLEMENTS

          OMNIBUS AMENDMENT, dated as of March 2, 2010 (this “Amendment”), to the Supplements
(as hereinafter described) to the Amended and Restated Indenture, dated as of November 1, 2007 (as
amended and restated, the “Indenture”), between American Express Issuance Trust, a
statutory trust organized under the laws of the State of Delaware, as Issuer (the
"Issuer”), and The Bank of New York Mellon (formerly The Bank of New York), a New York
banking corporation, as Indenture Trustee (the “Indenture Trustee”) and as the initial
Securities Intermediary.

RECITALS

          WHEREAS, the Issuer and the Indenture Trustee have previously entered into (i) the Series
2005-1 Indenture Supplement, dated as of September 16, 2005, (ii) the Series 2005-2 Indenture
Supplement, dated as of September 16, 2005, (iii) the Series 2007-1 Indenture Supplement, dated as
of November 1, 2007, (iv) the Series 2007-2 Indenture Supplement, dated as of November 1, 2007, (v)
the Series 2008-1 Indenture Supplement, dated as of April 3, 2008, and (vi) the Series 2008-2
Indenture Supplement, dated as of August 7, 2008.

          WHEREAS, the indenture supplements listed in the preceding paragraph are, collectively and in
each case as amended to date, the “Supplements”.

          WHEREAS, pursuant to Section 10.01 of the Indenture, the Issuer has delivered to the Indenture
Trustee and to Wilmington Trust Company (the “Owner Trustee”) an Officer’s Certificate to
the effect that the Issuer reasonably believes that this Amendment will not have an Adverse Effect
and is not reasonably expected to have an Adverse Effect at any time in the future.

          WHEREAS, the Issuer and the Indenture Trustee have satisfied all conditions precedent
contained in the Indenture to entering into this Amendment and this Amendment is authorized and
permitted under the Indenture.

          NOW, THEREFORE, in consideration of the mutual agreements herein contained, and other good and
valuable consideration, the receipt and adequacy of which are hereby acknowledged, each party
hereto agrees as follows:

ARTICLE I

DEFINITIONS

     SECTION 1.01. Defined Terms Not Defined Herein. All capitalized terms used herein
that are not defined herein shall have the meanings ascribed to them in the respective Supplements
or the Indenture, as the case may be.

 

 

ARTICLE II

AMENDMENTS TO SUPPLEMENTS

     SECTION 2.01. Amendment to Exhibits. Each Supplement shall be amended by deleting
Exhibit B-1 thereto and inserting in its place Exhibit B-1, which shall be in the form attached as
Exhibit B-1 to this Amendment.

ARTICLE III

MISCELLANEOUS

     SECTION 3.01. Ratification of Supplements. As amended by this Amendment, the
Supplements are in all respects ratified and confirmed and each Supplement, as amended by this
Amendment, shall be read, taken and construed as one and the same instrument.

     SECTION 3.02. Counterparts. This Amendment may be executed in two or more
counterparts, and by different parties on separate counterparts, each of which shall be an
original, but all of which shall constitute one and the same instrument.

     SECTION 3.03. GOVERNING LAW. THIS AMENDMENT SHALL BE CONSTRUED IN ACCORDANCE WITH THE
LAWS OF THE STATE OF NEW YORK, WITHOUT REFERENCE TO ITS CONFLICT OF LAW PROVISIONS, AND THE
OBLIGATIONS, RIGHTS AND REMEDIES OF THE PARTIES HEREUNDER SHALL BE DETERMINED IN ACCORDANCE WITH
SUCH LAWS.

     SECTION 3.04. Effectiveness. The amendments provided for by this Amendment shall
become effective as of January 1, 2010 upon receipt by the Indenture Trustee and the Owner Trustee
of the following:

     (a) written confirmation from each Note Rating Agency to the effect that the terms of
this Amendment will not cause a Ratings Effect;

     (b) an Officer’s Certificate from the Issuer to the effect that the Issuer reasonably
believes that this Amendment will not have an Adverse Effect and is not reasonably expected
to have an Adverse Effect at any time in the future;

     (c) an Issuer Tax Opinion; and

     (d) counterparts of this Amendment, duly executed by the parties hereto.

     SECTION 3.05 Limitation of Liability. It is expressly understood and agreed by the
parties hereto that (a) this Amendment is executed and delivered by Wilmington Trust Company, not
individually or personally but solely as Owner Trustee of the Issuer, in the exercise of the powers
and authority conferred and vested in it, (b) each of the representations, undertakings and
agreements herein made on the part of the Issuer is made and intended not as a personal
representation, undertaking and agreement, as the case may be, by Wilmington Trust Company but
is made and intended for the purpose of binding only the Issuer, (c) nothing herein contained

2

 

shall
be construed as creating any liability on Wilmington Trust Company, individually or personally, to
perform any covenant either expressed or implied contained herein, all such liability, if any,
being expressly waived by the parties hereto and by any person claiming by, through or under the
parties hereto and (d) under no circumstances shall Wilmington Trust Company be personally liable
for the payment of any indebtedness or expenses of the Issuer or be liable for the breach or
failure of any obligation, representation, warranty or covenant made or undertaken by the Issuer
under this Amendment or any other related documents.

[Signature page follows.]

3

 

     IN WITNESS WHEREOF, the Issuer and the Indenture Trustee have caused this Amendment to be duly
executed by their respective officers as of the day and year first above written.

	 	 	 	 	 	 	 
	 

	 	AMERICAN EXPRESS ISSUANCE TRUST,	 	 
	 

	 	as Issuer	 	 
	 
	 	 	 	 	 	 
	 

	 	By:
	 	WILMINGTON TRUST COMPANY, not in its individual capacity but solely as
Owner Trustee on behalf of the Trust
	 	 

	 	 	 	 	 
	 	 	 
	 	By:  	/s/ Bethany J. Taylor
 	 
	 	 	Name:  	Bethany J. Taylor 	 
	 	 	Title:  	Financial Services Officer 	 
	 
	 	THE BANK OF NEW YORK MELLON,

as Indenture Trustee and Securities Intermediary

 	 
	 	By:  	/s/ Catherine L. Cerilles
 	 
	 	 	Name:  	Catherine L. Cerilles 	 
	 	 	Title:  	Vice President 	 
	 

[Omnibus Amendment to Indenture Supplements]

4

 

EXHIBIT B-1

FORM OF MONTHLY NOTEHOLDERS’ STATEMENT

AMERICAN EXPRESS ISSUANCE TRUST

SERIES 200[_]-[_]

     Pursuant to (i) the Amended and Restated Indenture, dated as of November 1, 2007 (hereinafter
as such agreement may be from time to time, amended or otherwise modified, the
“Indenture”), between American Express Issuance Trust (the “Issuer” or the
“Trust”), and The Bank of New York, as indenture trustee (the “Indenture Trustee”),
as supplemented by the Indenture Supplement, dated as of [___], 200[_] (the “Indenture
Supplement”), between the Issuer and the Indenture Trustee and (ii) the Amended and Restated
Transfer and Servicing Agreement, dated as of November 1, 2007 (hereinafter as such agreement may
be from time to time, amended or otherwise modified, the “Transfer and Servicing
Agreement”), among American Express Receivables Financing Corporation V LLC, as transferor,
American Express Travel Related Services Company, Inc., as servicer and administrator
(“TRS” or the “Servicer”), the Issuer and the Indenture Trustee, TRS as Servicer is
required to prepare certain information each month regarding current payments to the Series
200[_]-[_] Noteholders and the performance of the Trust during the previous monthly period. The
information which is required to be prepared with respect to the Payment Date of [     ], and with respect to the performance of the Trust is set forth below. Certain of the
information is presented on the basis of an Outstanding Dollar Principal Amount of $1,000 per
Series 200[_]-[_] Note (a “Note”). Certain other information is presented based on the
aggregate amounts for the Trust as a whole. Capitalized terms used in this Monthly Statement have
their respective meanings set forth in the Indenture, the Indenture Supplement and the Transfer and
Servicing Agreement.

	 	A)	 	Information regarding payments in
respect of the Class A Notes per $1,000
Outstanding Dollar Principal Amount

	 	 	 	 	 	 
	(1	)	 	The total amount of
the payment in respect of the Class A Notes
	 	$                    
	 	 	 	 	 	 
	(2	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class A Monthly Interest
	 	$                    
	 	 	 	 	 	 
	(3	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class A Monthly Interest previously
due but not distributed on a prior Payment
Date
	 	$                    
	 	 	 	 	 	 
	(4	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class A Additional Interest
	 	$                    

B-1-1

 

	 	 	 	 	 	 
	(5	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class A Additional Interest
previously due but not distributed on a prior
Payment Date
	 	$                    
	 	 	 	 	 	 
	(6	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of principal of the Class A Notes
	 	$                    

	 	B)	 	Information regarding payments in
respect of the Class B Notes, per $1,000 Outstanding
Dollar Principal Amount

	 	 	 	 	 	 
	(1	)	 	The total amount of
the payment in respect of the Class B Notes
	 	$                    
	 	 	 	 	 	 
	(2	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class B Monthly Interest
	 	$                    
	 	 	 	 	 	 
	(3	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class B Monthly Interest previously
due but not distributed on a prior Payment
Date
	 	$                    
	 	 	 	 	 	 
	(4	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class B Additional Interest
	 	$                    
	 	 	 	 	 	 
	(5	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class B Additional Interest
previously due but not distributed on a prior
Payment Date
	 	$                    
	 	 	 	 	 	 
	(6	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of principal of the Class B Notes
	 	$                    

	 	C)	 	Information regarding payments in
respect of the Class C Notes, per $1,000 Outstanding
Dollar Principal Amount

	 	 	 	 	 	 
	(1	)	 	The total amount of
the payment in respect of Class C Notes
	 	$                    
	 	 	 	 	 	 
	(2	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class C Monthly Interest
	 	$                    

B-1-2

 

	 	 	 	 	 	 
	(3	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class C Monthly Interest previously
due but not distributed on a prior Payment
Date
	 	$                    
	 	 	 	 	 	 
	(4	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class C Additional Interest
	 	$                    
	 	 	 	 	 	 
	(5	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of Class C Additional Interest
previously due but not distributed on a prior
Payment Date
	 	$                    
	 	 	 	 	 	 
	(6	)	 	The amount of the
payment set forth in paragraph (1) above in
respect of principal of the Class C Notes
	 	$                    

	 	 	 	 	 
	 	AMERICAN EXPRESS TRAVEL RELATED

SERVICES COMPANY, INC., as Servicer

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

B-1-3

 

 

FORM OF MONTHLY SERVICER STATEMENT

AMERICAN EXPRESS ISSUANCE TRUST

	 	 	 	 	 
	Monthly Period:
	 	 	[_]/[_]/[_] to
 [_]/[_]/[_]	 
	Record Date:
	 	 	[_]/[_]/[_]	 
	Payment Date:
	 	 	[_]/[_]/[_]	 

	 	 	 	 	 
	 	 	TRUST TOTALS
	
TRUST ACTIVITY

	1. Number of days in Monthly Period
	 	 	[_]	 
	2. Beginning of Monthly Period Number of Accounts
	 	 	[_]	 
	3. Beginning Principal Receivables, including any additions
or removals during the Monthly Period
	 	$	[_]	 
	3a. Addition of Principal Receivables
	 	$	[_]	 
	3b. Removal of Principal Receivables
	 	$	[_]	 
	4. Beginning Invested Amount of Collateral Certificates
	 	$	[_]	 
	5. Beginning Excess Funding Account Amount
	 	$	[_]	 
	6a. Beginning Required Pool Balance
	 	$	[_]	 
	6b. Beginning Pool Balance
	 	$	[_]	 
	7. Beginning Available Overconcentration Account Amount
	 	$	[_]	 
	8. New Principal Receivables
	 	$	[_]	 
	9. Principal Collections
	 	$	[_]	 
	10. Gross Default Amount
	 	$	[_]	 
	11. Ending Principal Receivables
	 	$	[_]	 
	12. Ending Invested Amount of Collateral Certificates
	 	$	[_]	 
	13. Ending Excess Funding Account Amount
	 	$	[_]	 
	14. Ending Pool Balance
	 	$	[_]	 
	15. Ending Required Pool Balance
	 	$	[_]	 
	16. Ending Available Overconcentration Account Amount
	 	$	[_]	 
	17. Required Overconcentration Account Amount
	 	$	[_]	 
	18. End of Monthly Period Number of Accounts
	 	 	[_]	 

B-1-4

 

 

	 	 	 	 	 
	 	 	TRUST TOTALS
	TRUST PERFORMANCE	 	 	 	 
	1. Principal Collections
	 	$	[_]	 
	2. Principal Payment Rate
	 	 	[_]	%
	3. Net Default Amount
	 	$	[_]	 
	4. Annualized Net Default Rate
	 	 	[_]	%
	5. Gross Default Amount
	 	$	[_]	 
	6. Annualized Gross Default Rate
	 	 	[_]	%
	7. Finance Charge Collections
	 	$	[_]	 
	8. Trust Portfolio Yield (Net of
Defaults)
	 	 	[_]	%
	9. Delinquencies
	 	 	 	 
	31-60 Days Delinquent
	 	$	[_]	 
	61-90 Days Delinquent
	 	$	[_]	 
	90+ Days Delinquent
	 	$	[_]	 
	Total 30+ Days Delinquent
	 	$	[_]	 
	 	 	 	 	 
	TRANSFEROR AMOUNT	 	 	 	 
	1. Beginning Pool Balance
	 	$	[_]	 
	2. Beginning Nominal Liquidation Amount
	 	$	[_]	 
	3. Beginning Transferor Amount
	 	$	[_]	 
	4. Ending Pool Balance
	 	$	[_]	 
	5. Ending Nominal Liquidation Amount (after giving effect to any
principal payments on the related Payment Date)
	 	$	[_]	 
	6. Ending Transferor Amount (after giving effect to any
principal payments on the related Payment Date)
	 	$	[_]	 
	7. Ending Required Transferor Amount
	 	$	[_]	 

B-1-5

 

 

AMERICAN EXPRESS ISSUANCE TRUST

SERIES 200[_]-[_]

	 	 	 	 	 
	SERIES 200[_]-[_] NOMINAL LIQUIDATION AMOUNT AS OF THE RELATED PAYMENT DATE	 	 	 	 
	1. Beginning Series 200[_]-[_] Nominal Liquidation Amount
	 	$	[_]	 
	2. Reimbursement of previous reductions in the Series
200[_]-[_] Nominal Liquidation Amount
	 	$	[_]	 
	3. Investor Charge-Offs
	 	$	[_]	 
	4. Reallocated Principal Collections
	 	$	[_]	 
	5. Principal Funding Account Deposit/(Withdrawal)
	 	$	[_]	 
	6. Payments of principal of the Series 200[_]-[_] Notes
	 	$	[_]	 
	7. Ending Series 200[_]-[_] Nominal Liquidation Amount
	 	$	[_]	 

	 	 	 	 	 	 	 	 	 
	REALLOCATION GROUP [_] ALLOCATIONS	 	Trust Totals	 	Group Totals
	1. Nominal Liquidation Amount
	 	 	 	 	 	$	[_]	 
	2. Finance Charge Collections
	 	$	[_]	 	 	$	[_]	 
	3. Interest
	 	 	 	 	 	$	[_]	 
	4. Net Default Amount
	 	 	 	 	 	$	[_]	 
	5. Servicing Fee paid to the servicer
	 	 	 	 	 	$	[_]	 
	6. Additional Amounts
	 	 	 	 	 	$	[_]	 

	 	 	 	 	 
	SERIES 200[_]-[_] ALLOCATIONS	 	 	 	 
	1. Reallocation Group
	 	 	[_]	 
	2. Shared Excess Available Finance Charge Collections Group
	 	 	[_]	 
	3. Shared Excess Available Principal Collections Group
	 	 	[_]	 
	4. Opening Principal Funding Account Balance
	 	$	[_]	 
	5. Series 200[_]-[_] Floating Allocation Percentage
	 	 	[_]	%
	6. Series 200[_]-[_] Finance Charge Collections
	 	$	[_]	 
	7. Series 200[_]-[_] Reallocation Group [_] Finance Charge
Collections
	 	$	[_]	 
	8. Net Investment Proceeds from Principal Funding Account
	 	$	[_]	 
	9. Amounts withdrawn from the Accumulation Reserve Account
	 	$	[_]	 

B-1-1

 

	 	 	 	 	 
	SERIES 200[_]-[_] ALLOCATIONS	 	 	 	 
	10. Series 200[_]-[_] Available Finance Charge Collections
	 	$	[_]	 
	11. Series 200[_]-[_] Allocation of Shared Excess Available Finance
Charge Collections
	 	$	[_]	 
	12. Series 200[_]-[_] LIBOR Determination Date
	 	 	[_]	 
	13. Series 200[_]-[_] Monthly Interest ([Date] to [Date])
	 	$	[_]	 
	14. Series 200[_]-[_] Servicing Fee paid to the servicer
	 	$	[_]	 
	15. Series 200[_]-[_] Default Amount
	 	$	[_]	 
	16. Series 200[_]-[_] Principal Allocation Percentage
	 	 	[_]	%
	17. Series 200[_]-[_] Allocation of Principal Collections
	 	$	[_]	 
	18. Series 200[_]-[_] Allocation of Shared Excess Available
Principal Charge Collections
	 	$	[_]	 
	19. Series 200[_]-[_] Allocation of amounts withdrawn from the
Overconcentration Account
	 	$	[_]	 

	 	 	 	 	 
	APPLICATION OF SERIES 200[_]-[_] AVAILABLE FINANCE CHARGE COLLECTIONS	 	 	 	 
	1. Series 200[_]-[_] Available Finance Charge Collections
	 	$	[_]	 
	2. Class A Notes ($[_])
	 	 	 	 
	a. Class A Monthly Interest (Note Interest Rate: [_]%)
	 	$	[_]	 
	b. Class A Outstanding Monthly Interest
	 	$	[_]	 
	c. Class A Additional Interest
	 	$	[_]	 
	d. Class A Outstanding Additional Interest
	 	$	[_]	 
	3. Class B Notes ($[_])
	 	 	 	 
	a. Class B Monthly Interest (Note Interest Rate: [_]%)
	 	$	[_]	 
	b. Class B Outstanding Monthly Interest
	 	$	[_]	 
	c. Class B Additional Interest
	 	$	[_]	 
	d. Class B Outstanding Additional Interest
	 	$	[_]	 
	4. Class C Notes ($[_])
	 	 	 	 
	a. Class C Monthly Interest (Note Interest Rate: [_]%)
	 	$	[_]	 
	b. Class C Outstanding Monthly Interest
	 	$	[_]	 
	c. Class C Additional Interest
	 	$	[_]	 
	d. Class C Outstanding Additional Interest
	 	$	[_]	 
	5. Series 200[_]-[_] Servicing Fee paid to servicer
	 	$	[_]	 

B-1-2

 

	 	 	 	 	 
	APPLICATION OF SERIES 200[_]-[_] AVAILABLE FINANCE CHARGE COLLECTIONS	 	 	 	 
	6. Amount equal to Series 200[_]-[_] Default Amount treated as
Series 200[_]-[_] Available Principal Collections
	 	$	[_]	 
	7. Amount equal to unreimbursed reductions in the Series
200[_]-[_] Nominal Liquidation Amount treated as Series
200[_]-[_] Available Principal Collections
	 	$	[_]	 
	8. Deposited to the Accumulation Reserve Account
	 	$	[_]	 
	9. Deposited to the Class C Reserve Account
	 	$	[_]	 
	10. In the event of default and acceleration, amount up to the
outstanding dollar principal amount of the Series 200[_]-[_]
notes treated as Series 200[_]-[_] Available Principal
Collections
	 	$	[_]	 
	11. Remaining amount treated as Shared Excess Available Finance
Charge Collections available for allocation to other series in
Shared Excess Available Finance Charge Collections Group [_]
	 	$	[_]	 
	12. Remaining
amount paid to the holder of the Transferor Interest
	 	$	[_]	 

	 	 	 	 	 	 	 	 	 
	APPLICATION OF SHARED EXCESS AVAILABLE FINANCE CHARGE COLLECTIONS ALLOCATED TO SERIES 200[_]-[_]	 	 	 	 	 	 	 	 
	1. Shared Excess Available Finance Charge Collections
	 	$	[_]	 	 	 	 	 
	2. Applied to fund Class A Monthly Interest and Class A
Additional Interest and any past due Class A Monthly Interest
and Class A Additional Interest
	 	$	[_]	 	 	 	 	 
	3. Applied to fund Class B Monthly Interest and Class B
Additional Interest and any past due Class B Monthly Interest
and Class B Additional Interest
	 	$	[_]	 	 	 	 	 
	4. Applied to fund Class C Monthly Interest and Class C
Additional Interest and any past due Class C Monthly Interest
and Class C Additional Interest
	 	$	[_]	 	 	 	 	 
	5. Applied to unpaid Series 200[_]-[_] Servicing Fee
	 	$	[_]	 	 	 	 	 
	6. Amount equal to Series 200[_]-[_] Default Amount treated as
Series 200[_]-[_] Available Principal Collections
	 	$	[_]	 	 	 	 	 
	7. Amount equal to unreimbursed reductions in the Series
200[_]-[_] Nominal Liquidation Amount treated as Series
200[_]-[_] Available Principal Collections
	 	$	[_]	 	 	 	 	 
	8. Deposited to the Accumulation Reserve Account
	 	$	[_]	 	 	 	 	 
	9. Deposited to the Class C Reserve Account
	 	$	[_]	 	 	 	 	 
	10. In the event of default and acceleration, amount up to the
outstanding dollar principal amount of the Series 200[_]-[_]
Notes treated as Series 200[_]-[_] Available Principal
Collections
	 	$	[_]	 	 	 	 	 

B-1-3

 

	 	 	 	 	 
	APPLICATION OF SHARED EXCESS AVAILABLE FINANCE CHARGE COLLECTIONS ALLOCATED TO SERIES 200[_]-[_]	 	 	 	 
	11. Remaining amount treated as Shared Excess Available Finance
Charge Collections available to cover Series Available Finance
Charge Collections Shortfalls
	 	$	[_]	 
	12. Remaining amount paid to the holder of the Transferor
Interest
	 	$	[_]	 
	 	 	 	 	 
	PRINCIPAL COLLECTIONS	 	 	 	 
	1. Series 200[_]-[_] Principal Allocation Percentage
	 	 	[_]	%
	2. Series 200[_]-[_] Principal Collections
	 	$	[_]	 
	3. Reallocated Principal Collections required to pay
shortfalls in interest on the Class A Notes or the Class B
Notes or shortfalls in the Series 200[_]-[_] Servicing Fee and
past due amounts thereon
	 	$	[_]	 
	4. Item 2 minus Item 3
	 	$	[_]	 
	5. Other amounts treated as Series 200[_]-[_] Available
Principal Collections
	 	$	[_]	 
	6. Series 200[_]-[_] Available Principal Collections
(total of items 4 and 5)
	 	$	[_]	 
	 	 	 	 	 
	APPLICATION OF AVAILABLE PRINCIPAL COLLECTIONS DURING REVOLVING PERIOD	 	 	 	 
	1. Treated as Shared Excess Available Principal
Collections
	 	$	[_]	 
	 	 	 	 	 
	APPLICATION OF PRINCIPAL COLLECTIONS DURING CONTROLLED ACCUMULATION PERIOD	 	 	 	 
	1. Principal Funding Account
	 	[NA]
	2. Treated as Shared Excess Available Principal
Collections
	 	[NA]
	 	 	 	 	 
	APPLICATION OF PRINCIPAL COLLECTIONS DURING EARLY AMORTIZATION PERIOD	 	 	 	 
	1. Class A Noteholders
	 	[NA]
	2. Class B Noteholders
	 	[NA]
	3. Class C Noteholders
	 	[NA]

B-1-4

 

	 	 	 	 	 
	APPLICATION OF PRINCIPAL COLLECTIONS DURING EARLY AMORTIZATION PERIOD	 	 	 	 
	4. Treated as Shared Excess Available Principal
Collections
	 	 	[NA]	 
	 	 	 	 	 
	APPLICATION OF SHARED EXCESS AVAILABLE PRINCIPAL COLLECTIONS ALLOCATED TO SERIES 200[_]-[_]	 	 	 	 
	1. Series 200[_]-[_] Available Principal Collections
Shortfall
	 	$	[_]	 
	2. Shared Excess Available Principal Collections
	 	$	[_]	 
	3. During the Controlled Accumulation Period:
	 	 	 	 
	3a. Amount deposited in the Principal Funding Account
	 	$	[_]	 
	4. During the Early Amortization Period:
	 	 	 	 
	4a. Paid to the Class A Noteholders
	 	$	[_]	 
	4b. Paid to the Class B Noteholders
	 	$	[_]	 
	4c. Paid to the Class C Noteholders
	 	$	[_]	 
	 	 	 	 	 
	SERIES 200[_]-[_] PRINCIPAL FUNDING, ACCUMULATION, CLASS C RESERVE ACCOUNT	 	 	 	 
	1. Principal Funding Account
	 	 	 	 
	Opening Balance
	 	$	[_]	 
	Additions
	 	$	[_]	 
	Withdrawals
	 	$	[_]	 
	Ending Balance
	 	$	[_]	 
	2. Investment Proceeds on Principal Funding Account
	 	$	[_]	 
	3. Accumulation Reserve Account Amount
	 	 	 	 
	Opening Balance
	 	$	[_]	 
	Additions
	 	$	[_]	 
	Withdrawals
	 	$	[_]	 
	Ending Balance
	 	$	[_]	 
	4.
Investment Proceeds on Accumulation Reserve Account
	 	$	[_]	 
	5. Accumulation Reserve Account target amount
	 	$	[_]	 
	6. Class C Reserve Account Amount
	 	 	 	 
	Opening Balance
	 	$	[_]	 
	Additions
	 	$	[_]	 
	Withdrawals
	 	$	[_]	 

B-1-5

 

	 	 	 	 	 
	SERIES 200[_]-[_] PRINCIPAL FUNDING, ACCUMULATION, CLASS C RESERVE ACCOUNT	 	 	 	 
	Ending Balance
	 	$	[_]	 
	7. Investment Proceeds on Class C Reserve Account
	 	$	[_]	 
	8. Required Class C Reserve Account amount
	 	$	[_]	 
	 	 	 	 	 
	PORTFOLIO PERFORMANCE DATA	 	 	 	 
	1. Series 200[_]-[_] Portfolio Yield
	 	 	 	 
	Current Monthly Period
	 	 	[_]	%
	Prior Monthly Period
	 	 	[_]	%
	Second Prior Monthly Period
	 	 	[_]	%
	2. Series 200[_]-[_] Quarterly Portfolio Yield
	 	 	[_]	%
	3. Series 200[_]-[_] Base Rate
	 	 	 	 
	Current Monthly Period
	 	 	[_]	%
	Prior Monthly Period
	 	 	[_]	%
	Second Prior Monthly Period
	 	 	[_]	%
	4. Series 200[_]-[_] Quarterly Base Rate
	 	 	[_]	%
	5. Series 200[_]-[_] Excess Spread Percentage
	 	 	 	 
	Current Monthly Period
	 	 	[_]	%
	Prior Monthly Period
	 	 	[_]	%
	Second Prior Monthly Period
	 	 	[_]	%
	6. Series 200[_]-[_] Quarterly Excess Spread Percentage
	 	 	[_]	%
	Is the Quarterly Excess Spread Percentage greater than the
Required Excess Spread Percentage?
	 	 	[YES]	 
	7. Principal Payment Rate
	 	 	 	 
	Current Monthly Period
	 	 	[_]	%
	Prior Monthly Period
	 	 	[_]	%
	Second Prior Monthly Period
	 	 	[_]	%
	8. Quarterly Principal Payment Rate
	 	 	[_]	%
	Is the Quarterly Principal Payment Rate greater than 60%?
	 	 	[YES]	 

	 	 	 	 	 
	 	AMERICAN EXPRESS TRAVEL RELATED SERVICES
 COMPANY,
INC., as Servicer
 	 
	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

B-1-6exv10w21

Exhibit 10.21

BUILDERS FIRSTSOURCE, INC.

2007 INCENTIVE PLAN

NON-QUALIFIED STOCK OPTION AGREEMENT

     THIS NON-QUALIFIED STOCK OPTION AGREEMENT (the “Agreement”), dated as of                                          is made
by and between Builders FirstSource, Inc., a Delaware corporation (the “Company”), and
                                         (the “Optionee”).

     WHEREAS, the Company has adopted the Builders FirstSource Inc., 2007 Incentive Plan (as
amended from time to time, the “Plan”), pursuant to which options may be granted to purchase Stock;
and

     WHEREAS, the Company desires to grant to the Optionee a non-qualified stock option (or “NQSO”)
to purchase the number of shares of Stock provided for herein;

     NOW, THEREFORE, in consideration of the recitals and the mutual agreements herein contained,
the parties hereto agree as follows:

Section 1. Grant of Option

     (a) Grant of Option. The Company hereby grants to the Optionee an Option to purchase ___
shares of Stock on the terms and conditions set forth in this Agreement and as otherwise provided
in the Plan. The Option is not intended to be treated, and shall not be construed, as an ISO.

     (b) Incorporation of Plan. The provisions of the Plan are hereby incorporated herein by
reference. Except as otherwise expressly set forth herein, this Agreement shall be construed in
accordance with the provisions of the Plan and any capitalized terms not otherwise defined in this
Agreement shall have the definitions set forth in the Plan. The Committee shall have final
authority to interpret and construe the Plan and this Agreement and to make any and all
determinations under them, and its decision shall be binding and conclusive upon the Optionee and
his/her legal representative in respect of any questions arising under the Plan or this Agreement.

Section 2. Terms and Conditions of Option

     (a) Exercise Price. The price at which the Optionee shall be entitled to purchase shares of
Stock upon the exercise of all or any portion of the Option shall be $  per share.

     (b) Expiration Date. The Option shall expire at the close of business on the tenth
anniversary of the date of this Agreement.

     (c) Exercisability of Option. Subject to the other terms of this Agreement regarding the
exercisability of the Option, the Option shall become exercisable as of the
dates set forth below for the cumulative percentages of shares of Stock set forth below,

 

 

provided the Optionee is employed by the Company or an Affiliate as of each such date:

	 	 	 	 	 
	 

	 	Date
	 	Percentage of Shares
	 

The Committee may, but shall not be required to, provide at any time for the acceleration of the
schedule set forth above.

     (d) Method of Exercise. The Option may be exercised only by written notice in such form as
the Company may adopt from time to time, delivered in person or by mail in accordance with Section
3(a) and accompanied by payment therefor or pursuant to such other procedure as the Company may
adopt from time to time. The purchase price of the shares of Stock shall be paid to the Company
(i) in cash or its equivalent, (ii) if outside of a period in which Company policy prohibits the
Optionee from trading in the Company’s securities (a “Blackout Period”), by tendering to the
Company shares of Stock already owned by the Optionee that have been held by the Optionee for no
less than six months following the date of their purchase and have a total Fair Market Value less
than or equal to the aggregate exercise price, (iii) if outside a Blackout Period, to the extent
permitted by law, by a “broker cashless exercise” procedure approved by the Committee, or (iv) by a
combination of the foregoing methods. If requested by the Committee, the Optionee shall deliver
this Agreement evidencing the Option to the Secretary of the Company who shall endorse thereon a
notation of such exercise and return such Agreement to the Optionee. A minimum of 100 shares of
Stock must be purchased upon the exercise of the Option unless a lesser number of shares of Stock
so purchased constitute the total number of shares of Stock then purchasable under the Option.

     (e) Exercise Following Cessation of Service. Subject to Section 2(g), (i) on the date that
the Optionee ceases to be employed by the Company or an Affiliate (the “Employment Termination
Date”), that portion of the Option that is not then exercisable shall immediately terminate and
(ii) that portion of the Option that is exercisable on the Employment Termination Date shall remain
exercisable and shall terminate as follows:

     (i) If the Optionee’s Termination of Service (as defined below) is due to his death or
disability, as determined by the Board, the Option (to the extent exercisable on the
Employment Termination Date) shall be exercisable for a period of six months following
Termination of Service, and shall thereafter terminate;

     (ii) If the Optionee’s Termination of Service is effected by the Company or an
Affiliate for Cause (as defined below), the Option shall terminate on the date of the
Optionee’s Termination of Service;

     (iii) If the Optionee voluntarily effects his Termination of Service, the
Option (to the extent exercisable on the Employment Termination Date) shall be

2

 

exercisable for a period of 60 days following such Termination of Service, and shall
thereafter terminate; and

     (iv) If the Optionee’s Termination of Service is for any other reason, the Option (to
the extent exercisable on the Employment Termination Date) shall be exercisable for a
period of 60 days following such Termination of Service, and shall thereafter terminate.

For purposes of this Agreement, “Termination of Service” shall mean the later of (i) the Employment
Termination Date or (ii) termination of Optionee’s service as a director of the Company.

For purposes of this Agreement, “Cause” means (i) any act of fraud, gross negligence, or dishonesty
in the performance of the Optionee’s duties or the willful failure by the Optionee to perform
Optionee’s duties, (ii) engaging in any action with the intention of causing harm or damage to any
of the Company’s operations, (iii) conviction of a felony, or (iv) obtaining personal gain from a
transaction in which the Optionee has a conflict of interest with the Company.

Notwithstanding the foregoing, no provision in this Section 2(e) shall extend the exercise period
of an Option beyond its original term set forth in Section 2(b).

     (f) Nontransferability. The Option shall not be transferable by the Optionee other than by
will or the laws of descent and distribution.

     (g) Rights as a Stockholder. The Optionee shall not be deemed for any purpose to be the owner
of any shares of Stock subject to the Option unless, until, and to the extent that (i) the Option
shall have been exercised pursuant to its terms, (ii) the Company shall have issued and delivered
to the Optionee the shares of Stock for which the Option shall have been exercised, and (iii) the
Optionee’s name shall have been entered as a stockholder of record with respect to such shares of
Stock on the books of the Company.

     (h) Income Taxes. The Company may, in its discretion, require that the Optionee pay to the
Company at or after (as determined by the Committee) the time of exercise of any portion of the
Option any such additional amount as the Company deems necessary to satisfy its liability to
withhold federal, state, or local income tax or any other taxes incurred by reason of the exercise
or the transfer of shares of Stock thereupon. Such taxes may be paid to the Company (i) in cash or
its equivalent, (ii) if outside of a Blackout Period, by tendering to the Company shares of Stock
already owned by the Optionee having a Fair Market Value less than or equal to the amount of such
taxes, (iii) if outside a Blackout Period, by electing to have the Company withhold a portion of
the shares of Stock to be received upon exercise of such Option having a Fair Market Value less
than or equal to the amount of such taxes, (iv) if outside a Blackout Period, to the extent
permitted by law, by a “broker cashless exercise” procedure approved by the Committee, or (v) by a
combination of the foregoing methods.

3

 

Section 3. Miscellaneous

     (a) Notices. Any notice by the Optionee to the Company hereunder shall be in writing and
shall be deemed duly given only upon receipt thereof by the General Counsel of the Company at its
principal offices. Any notice by the Company to the Optionee shall be in writing and shall deemed
duly given if mailed or sent by overnight service to the Optionee at the address last specified to
the Company by the Optionee, Optionee’s residence, or Optionee’s address appearing on the books of
the Company.

     (b) No Right to Continued Employment. Nothing in the Plan or in this Agreement shall confer
upon the Optionee any right to continue in the employ of the Company or any Affiliate or shall
interfere with or restrict in any way the right of the Company and its Affiliates, which are hereby
expressly reserved, to remove, terminate, or discharge the Optionee at any time for any reason
whatsoever, with or without Cause.

     (c) Bound by Plan and Company Policy. By signing this Agreement, the Optionee (i)
acknowledges that Optionee has received a copy of the Plan and has had an opportunity to review the
Plan, (ii) agrees to be bound by all the terms and provisions of the Plan, and (iii) agrees not to
sell any Stock received upon exercise of an Option at a time when any law, rule, regulation, or
Company policy prohibits a sale.

     (d) Successors. The terms of this Agreement shall be binding upon and inure to the benefit of
the Company and its successors and assigns and of the Optionee and the beneficiaries, executors,
administrators, heirs, and successors of the Optionee.

     (e) Validity/Invalidity. The invalidity or unenforceability of any particular provision
hereof shall not affect the other provisions hereof, and this Agreement shall be construed in all
respects as if such invalid or unenforceable provision had been omitted.

     (f) Modifications. No change, modification, or waiver of any provision of this Agreement
shall be valid unless the same be in writing and signed by the parties hereto.

     (g) Entire Agreement. This Agreement and the Plan contain the entire agreement and
understanding of the parties hereto with respect to the subject matter contained herein and therein
and supersede all prior communications, representations, and negotiations in respect thereto.

     (h) Governing Law. This Agreement and the rights of the Optionee hereunder shall be construed
and determined in accordance with the laws of the State of Delaware other than the conflicts of law
provisions thereof.

     (i) Headings. The headings of the Sections hereof are provided for convenience only and are
not to serve as a basis for interpretation or construction, and shall not constitute a part, of
this Agreement.

     (j) Counterparts. This Agreement may be executed in counterparts, each of which shall be
deemed an original, but all of which together shall constitute one and the
same instrument.

4

 

     (k) Confidentiality. By signing this Agreement, Optionee agrees to keep confidential and not
to disclose to any person or entity information concerning the Company’s option program, the number
of Options covered by this Agreement, or any transactions between the Optionee and the Company
pursuant to this Agreement, except as required by applicable law.

     IN WITNESS WHEREOF, this Agreement has been executed and delivered by the parties hereto on
the ___day of                                         .

	 	 	 	 	 
	 	BUILDERS FIRSTSOURCE, INC.

 	 
	 	By:  	 	 
	 	 	 	 
	 	 	 	 
	 

	 	 	 	 	 
	 	 	 
	 	By:  	
 	 
	 	 	 	 
	 	 	 	 
	 
	 	Address:

 	 
	 	 	 
	 	 	 
	 	 	 
	 

5

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