MasterCard Debit Card Application

 

Date____________________

 

_______________________New MasterCard Debit Card        ________________Re-issue

                                                                                                                     ($10.00 charge)

 

 

Name's)_________________________________________________________________

 

Address_________________________________________________________________

 

City_______________________State______________Zip________________________

 

Home phone_________________Work phone__________________________________

 

Date of Birth________________________SS#__________________________________

 

Checking acct#___________________________Savings acct#_____________________

 

_______Hot card card (List reason)___________________________________________

( A $10.00 fee will be assessed for ALL re-issued cards.)

 

I understand that this card is the property of The Trust Bank and must be surrendered on demand.  I also understand that I must NOT carry my PIN # with my card and that it is my responsibility to maintain the confidentiality of my PIN# to prevent any unauthorized withdrawals from my account.  Please see our disclosures for your liabilities when using the Master Money card.  The undersigned agrees that all information is accurate and authorizes the bank to verify credit history by any means necessary, including preparation of a credit report by a credit-reporting agency.

 

 

 

Signature(s)

 

 

Bank use only

 

______________Approved        _____________Denied

 

 

 

New Card Number(s)