Debit Card Application

Account Information:

Account Number *

Primary Member Information:

Name

Phone Number

Email

Address

Joint Member Information (if applicable):

Name

Phone Number

Email

Disclosures

Please review the following information:

Electronic Fund Transfers/Your Rights & Responsibilities

By checking this box, I agree that I have read and understand the above EFT Disclosure. *

Yes, I agree

Fee Schedule

By checking this box, I agree that I have read and understand the above Fee Schedule. *

Yes, I agree

Do you want WSCU to authorize & pay overdrafts on my debit/ATM card transactions? *

Yes, Opt In

No, Opt Out

By signing this application, I/we hereby submit an application for a Wolverine State Credit Union MasterCard debit/ATM card. I/we agree to be bound to all of the terms and conditions governing the use of that card as outlined in the WSCU disclosure electronic funds transactions. I/we understand and agree that the disclosures will be provided to me by WSCU if my request is approved. I/we understand and agree that the credit union's decision to grant this request will be based on information provided on this application, along with past history and information obtained from a consumer reporting agency. I/we hereby authorize WSCU to obtain any consumer report for this purpose.

This application must be filled out with updated/current information before card(s) can be ordered. Cards are mailed to the address on file.

P.O. Boxes are NOT acceptable for mailing of cards.

Primary Member Signature *

Joint Member Signature (if applicable)

Thank You