Waterbury Telephone Federal Credit Union

ATM / Debit Card Application
Please print and mail to: 2457 East Main Street, Waterbury, CT 06708
or fax to: (203) 578-3079
 
This application can be used for a Visa Check Card. IN ORDER TO ISSUE A PERSONALIZED, INDIVIDUAL CARD TO EITHER SIGNER OF A JOINT ACCOUNT, EACH OWNER MUST FILL OUT A SEPARATE APPLICATION.

 
CARDHOLDER
 		 SOC. SEC. # DATE OF BIRTH
ADDRESS
 
CITY
 		 STATE ZIP
TELEPHONE (DAY)                                  (EVENING)
 
LICENSE NUMBER
 

I wish to access this account for Visa Check Card use:
 
SHARE DRAFT ACCOUNT #
 

Authorizations: By signing below, I am applying for a Waterbury Telephone Federal Credit Union Visa Check Card. I understand this is not a credit card and that the dollar amount of the purchases made with this card will be deducted from my share dreaft account only. I authorize Waterbury Telephone Federal Credit Union to verify the information provided above and to request a credit report if necessary. The ATM / Debit Card is available for qualified customers only. Other requirements apply. I agree to be bound by the terms and conditions covered in the appropriate Disclosure Statement and Cardholder Agreement.
 
SIGNATURE
 		 DATE

Personal Identification Number (PIN)
This number belongs to you and is the key to the security of your accounts. Once entered into our system, it is transformed and unavailable to anyone. If you forget your PIN or would like to change it, you must contact the Waterbury Telephone Federal Credit Union Customer Service Department.

To select your PIN, enter four numbers below and record in a safe place for your future reference.
 
PIN