Lost Or Stolen VISA Debit Card Form

Please print out, fill out, and fax this form to the credit union at 609-945-6299.

You must still call the credit union at 609-945-6200 or 800-404-8734 and the card company at 800-554-8969 to report your lost or stolen card.


DATE REPORTED TO PUFCU: _________________________________________________

NAME: ___________________________________________________________________

VISA DEBIT CARD #466001 _________________________________________________

I am reporting that my Princeton University Federal Credit Union VISA Debit Card has been lost/stolen.

If the card was reported stolen and suspected fraudulent transactions were made and the perpetrator(s) is apprehended, I understand that the credit union may prosecute the person(s) responsible to the fullest extent of the law.

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MEMBER - PRINT NAME

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MEMBER SIGNATURE

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MEMBER - SHARE ACCOUNT NUMBER

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PUFCU - EMPLOYEE