Princeton University Federal Credit Union - A Tradition of Financial Excellence - Applications

VISA Debit Card/ATM Application

Please print, complete and return form to Princeton University Federal Credit Union

Applicant

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LAST NAME, FIRST NAME, MIDDLE INITIAL (PLEASE PRINT)

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STREET ADDRESS

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APARTMENT NO./P.O. BOX NO.

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CITY, STATE, ZIP CODE

DAY TELEPHONE ( ____ ) _____ - __________ EVENING TELEPHONE ( ____ ) _____ - ___________

Co-Applicant *Must be joint owner on account

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LAST NAME, FIRST NAME, MIDDLE INITIAL (PLEASE PRINT)

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Account Number *Please note message for VISA Debit Card

Record Your PIN Here
(Choose all numbers, NO LETTERS)

Signature(s) Required

I/We hereby acknowledge that I/we have received a copy of your VISA Debit Card/ATM Card Cardholder Agreement and that I/we have read, understand and agree to be legally bound by the terms and conditions of such Agreement. I/We also acknowledge receipt of the disclosure statement informing me/us of my/our rights under the Electronic Funds Transfer Act.
X ________________________________	__________	X ________________________________	__________
APPLICANT'S SIGNATURE	DATE	CO-APPLICANT'S SIGNATURE	DATE
Please Note: *For a VISA Debit Card, your primary account will be your checking account and you must keep an available balance in that account to perform any VISA Debit Card POS transaction.

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PU FCU Use Only • REMARKS
Account Information If this is a joint application, be sure the accounts listed are the applicant's joint accounts

Account Number with Checking Account Digit