ATM/Debit Card Application

ATM/Debit Card Application

The University Credit Union Debit Card is linked to your UCU Checking Account.

	If you are not yet a member, please submit a Membership Application first, then open your account.
	If you do not currently have a checking account with the Credit Union and are applying for a debit card, apply by submitting an Online Account Application.
	To report a lost or stolen ATM or Debit Card 7 days a week, 24 hours a day, call 1-800-264-5578.

Please issue me a:

Debit Card ATM Card

Is this your first card or a reissue or a previous card?

New Reissue

Reason for reissue:

Lost Stolen Destroyed Other

Primary Cardholder Information

Member Name:

Social Security Number:

Date of Birth:

(xx/xx/xxxx)

UCU Account #:

Street Address:

City:

State:

Zip:

Home Phone Number:

Work Phone Number:

Email Address:

Permission to send information to your email address?

Yes No

Joint or Other Applicant Information If your card application is for joint account, you must also fill out this section of the application. If you are applying for an individual card, you can skip this section.
Joint Member Name:
Social Security Number:
Date of Birth:	(xx/xx/xxxx)
Home Address:
City:
State:
Zip:

Your new ATM or Debit Card should arrive in approximately 10 days. A system-generated pin will arrive separately three days prior to the arrival of the card. For any questions regarding issues with your card, please contact Melissa at 617-739-7447, Ext. 232.

Thank You. Upon receipt of this application, someone at University Credit Union will review your information and get back to you. We appreciate this opportunity to be your financial partner.

Debit Card users are subject to a total daily transaction limit of $500.

Please refer to the Schedule of Fees for any charges that may apply.

Member must be 18 years of age or older in order to obtain an ATM or Debit Card.

Reason for reissue:

Joint or Other Applicant Information