Weld Schools Credit Union
Debit/ATM Card Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

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The items marked with (*) are required fields.

General Information
Will there be a co-applicant on this application? Yes No
(If Yes, the co-applicant section has the same required fields as the primary applicant.)

I am interested in:
Check/Debit Card

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Primary Applicant
*Member Number
Checking Account Number
How your name should appear on card:
*Last Name
*First Name
Middle Name
*Social Security Number (TIN) --
*Date of Birth //
*Home Phone Number --
Work Phone Number -- ext.
Number -- ext.
Email Address
Drivers License #
Drivers License State
Mother's Maiden Name
Present Employer Name
Home Address
*Address 1
Address 2
*Zip -

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Additional Information
How would you prefer to be contacted?
Home Phone
Work Phone
Cell Phone
Email Address
Special Instructions/Comments

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By submitting this form, I authorized Weld Schools Credit Union to obtain a credit report and verify my employment information. Upon receipt of this form, Weld Schools Credit Union will review my Debit/ATM Card application and upon approval, will forward documentation to me for original signatures.

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