Visa® Debit Card Application

Please print this form and return it to POWERCO Credit Union.

POWERCO Credit Union offers a Visa® Debit Card for members who have a checking account. With 24-hour convenience and millions of locations worldwide, our members are never without access to their funds. Your Visa® Debit Card can be used for the following:

• As an ATM card for cash withdrawals.
• To pay for purchases conveniently without the hassle of writing a check.
• Can be used worldwide wherever Visa® is accepted.

The card is free to all qualified members and there is no transaction fee for purchases used as a Visa®. (Normal transaction fees apply on ATM transactions.)

Name:

Address:

City: State: Zip:

Social Security Number: Birth Date:

Issue a Visa® Debit Card in the Primary Owner's name.
Select a 4 digit PIN to be used for cash withdrawals

Issue a Visa® Debit Card in the Joint Owner's name.
Select a 4 digit PIN to be used for cash withdrawals

____________________________________________________
Primary Owner's Signature

____________________________________________________
Joint Owner's Signature

By signing above, member requests use of the Visa® Debit Card and agrees to abide by the terms and conditions as explained in the Account Information for Members and Fee Schedule. Member also agrees to allow POWERCO to obtain a credit report in connection with this application. For a copy of the Account Information for Members and Fee Schedule please contact a POWERCO staff member.

Approved by: _________________________________________________________________ Date: ____________________

Visa® Debit Card Number: ____________________________________________________________________________

Print and return to:

POWERCO Credit Union
471 Morrison Road Suite M.
Gahanna, OH 43230
Ph: 614-416-7588
Fax: 614-416-7580