Secure Debit Card Application

Applicant Information

• Account Number *
• First Name *
• Middle Name
• Last Name *
• Social Security Number *
• Date of Birth (mm/dd/yyyy) *
• Address
• City
• State
  AK AL AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC TN TX UT VT VA WA WV WI WY
• Zip
• Home Phone Number *
• Cell Phone Number
• Employer
• Month Hired
• Year Hired

Co-Applicant Information (if applicable)

• First Name
• Middle Name
• Last Name
• Social Security Number
• Date of Birth (mm/dd/yyyy)
• Home Phone Number
• Cell Phone Number
• Employer
• Month Hired
• Year Hired

This statement is submitted to obtain a check card and I certify that all information is true and complete. I authorize the credit union to verify or obtain further information it may deem necessary concerning my credit standing. If this application is approved and a check a card issued, by signing, using or permitting another to use the check card, I agree that I will be bound by the terms and conditions accompanying the Visa check card and all amendments. I understand that a Personal Identification Number (PIN) will be mailed to me in the event this application is approved. In the event WCCU elects not to issue a check card, I understand this will serve as an application for an WCCU Automated Teller Machine(ATM) card only.

• I (We) acknowledge and agree to the terms and conditions.