VISA CheckCard/ATM Card Application

VISA CheckCard/ATM Card Application (please print clearly in ink) s s I would like to apply for a VISA CheckCard.* s s Please issue a VISA CheckCard for Joint Owner (must be the joint owner on your Priority One Checking Account). s s I would like to apply for an ATM Card. s s Please issue an ATM Card for Joint Owner (must be the joint owner on your Priority One Checking Account). Other Options: s s Issue New s s CheckCard s s ATM Card s s PIN s s Issue Replacement s s CheckCard s s ATM Card s s PIN Member Number Primary Member Name Joint Owner Name Address City State Zip Home Phone Business Phone Social Security Number By signing below, I/we hereby apply for a Priority One Credit Union VISA
CheckCard/ATM card and agree that use of my VISA CheckCard/ATM card
constitutes my agreement to the terms of the Priority One Electronic Services
Disclosure and Agreement which will be sent to me with my card. Member Signature (do not print) Date Joint Owner Signature (do not print) Date Print out, complete, sign and mail to Priority One Credit
Union, Attn: Marketing, 1631 Huntington Drive,
South Pasadena, CA 91030 , or fax to (626) 441-1263. *Subject to ChexSystem and Priority One checking in good standing. ( ) ( ) s s Savings s s Checking s s No Charge s s ChexSystems Card # P/Off # Prepared By Date Approved by the following Priority One Officer: Signature/Title Date X X X FOR CREDIT UNION USE ONLY

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