ATM Debit Card Application

APPLY FOR AN ATM OR MASTERCARD DEBIT CARD

In order to apply for a card for your account, please complete the form below. If your card has been lost or stolen, or if you have any questions about completing the application, please contact us at (606) 376-5031 or (423) 569-6313.

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Select Card Type Select Card Type

ATM Card
MasterCard Check / Debit Card

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*X Required

Checking Account Number

*X Required

Savings Account Number

*X Required

Applicant

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First Name

Middle Name

Last Name

*X Required

Select Suffix (Not Required)

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*X Required

Social Security Number

*X Required

Date of Birth

*X Required

Mailing Address

Address 2

City

State

Zip Code

*X Required

Phone

*X Required

Email

*X Required

Only check if you want to op out of important news and updates Only check if you want to op out of important news and updates

Please do NOT email me important news and updates

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*X Required

How would you like to be contacted? How would you like to be contacted?

Phone
Email

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*X Required

Authorization

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By clicking the "I Accept" box below, the applicant(s) request(s) the described services and agrees to the terms and conditions governing the services, including any fees and charges. The applicant(s) agree(s) that all information is accurate and authorizes the financial institution to verify credit and employment history, if necessary, by any means, including preparation of a credit report by a credit agency. Check the "I Accept" box to indicate that you (the applicant) have read the agreement and accept its terms.

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Terms and Conditions Terms and Conditions

Yes, I agree to the Terms and Conditions

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*X Required