Debit Card Application

Thanks for your application!

Your application has been submitted and your debit card should arrive within

7-10 business days. If you need your debit card sooner, contact a personal banker for assistance with a temporary card.

Applicant Information

*First Name

*Middle Initial

*Last Name

Business Name

*Last 4 digits of Social Security number

*Date of Birth

*Street Address

*City

*State

*Zip Code

Home Or Business Phone

*Cell Phone

*Last 4 Digits of Personal or Business Checking Account for Purchases

One additional savings account or money market may be added to card for ATM access. If you would like this option, please list the last 4 digits of the savings or money market account to include

*Please select the type of debit card you would like to order:

Business Debit Card ($15/year/card)

Standard Debit Card ($15/year/card. Free with BreakFree or World Class checking account.)

Photo ID card ($20/year/card or $5 with BreakFree or World Class checking account.)

My Pic Card - Upload your photo here ($20/year/card or $5 with BreakFree or World Class checking account.)

Cardholder Acknowledgement

By completing this application, I/we agree to be bound by the terms and conditions of the debit card, and the electronic funds transfer disclosure, copies of which were provided at account opening. I/we agree not to use the debit card for illegal transactions (illegal gambling or otherwise). I/we understand that display of a payment card log by, for example, an online merchant, does not necessarily mean that transactions are lawful in all jurisdictions in which I/we as a cardholder may be located. I understand that receipt of such terms will be conclusively presumed by use of the card. If this is a joint application, the applicants shall be jointly and severally liable for any and all debit card transactions. I/we understand that issuance of a debit card requires approval by a bank officer.

To continue, confirm your agreement to the above statement by clicking the box next to "I agree." We will process your request and mail you any necessary information.

*I agree

Business Owner Acknowledgement - For Business Users Only

I authorize that I am the owner of the business listed. I understand that the cardholder will have access to the funds in the bank account(s) listed. I agree that I am responsible for monitoring the use of this debit card and will report any fraudulent or unauthorized transactions immediately. I understand that my business/organization is responsible for notifying the bank immediately when the authorized cardholder is no longer authorized to conduct transactions using a debit card. I understand that the employee/individual being assigned a debit card will have access to account balance information at an ATM and will have the ability to withdraw cash at an ATM or request cash back from a merchant.

To continue, confirm your agreement to the above statement by clicking the box next to "I agree." We will process your request and mail you any necessary information.

*I agree