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)