Fields marked (*) are required*

Email Address:*

First Name :

Last Name:.

Address:    

Home Phone Cell Phone Business Phone

SSN: DOB: Mother's Maden name

Account Number to be accessed with Debit Card:

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(Initial Each)


By Using the Debit Card, I agree to abide by the terms of the membership and account agreemeent and the electronic funds transfer agreement. I agree that i will not use my card for any transaction that is illegal under applicable federal, state, or local law


I have received the Debit Card Disclosure Notice


I have received the Debit Card Safety Guidelines


I give telco Plus Credit Union Permission to pull a copy of my credit report, if needed, to process approval of my debit Card

Your daily limit is POS-$750.00, ATM-$250.00. Total-$1000.00

Signed: Date:

To be completed by Credit Union Employee

To be completed by Credit Union Employee:

Information Taken by __________ Date _______ Approved by ___________ Date _________

Entered in Transfund by __________ Date _______

Debit Card Number 4 3 5 9 7 5 __ __ __ __ __ __ __ __ __ __

Entered in Teller Workspace/Products by __________ Date ________

Verified Transfund Report to Network File Maint. by __________ Date _______