Debit Card Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

Please Note: You must have a share draft account and be at least 18 years of age to receive a debit card. Members under 18 may have a debit card if an adult 18 or older signs as a responsible adult for the share draft account and debit card. If you wish to have a joint card, they must be listed as a joint owner on the account.

* - REQUIRED

General Information

Debit Card Application Account Type *

Individual Joint (Spouse, RDP, Co-Applicant)

NOTICE:

When requesting a primary or joint card, the named person(s) must be an owner to the checking account. The primary owner and joint(s) must sign to give consent to receive the card(s) and be responsible for card transactions.
If under 18 years of age and applying for a debit card, you must have an owner on the checking account who is at least 18 years of age and whom takes financial responsibility of the account. A signature must be obtained.

* Refers to RDP's in a state with RDP laws that provide for community property rights that mirror those of a spouse.

Primary Applicant

Member Number *

Share ID *

Personal Information

How should your name appear on card:

First Name *

Last Name *

Date of Birth *

SSN / TIN *

Driver's License State/No.

Email *

Home Phone

Mobile Phone

Work Phone

At least one phone number required

Mother's Maiden Name *

Present Employer Name

Current Residence

Address *

City *

State *

Zip Code *

Signature

You promise that everything you have stated in this application is correct to the best of your knowledge and that the above information is complete. If there are any important changes, you will notify us in writing immediately.

Typing your name(s) into the signature field(s) below will constitute an electronic signature and agreement to WEPCO's Electronic Signature Act Disclosure and EFT Agreement Disclosure.

Primary Applicant Signature *

Date *

Joint Applicant Signature *

Date *

Color

Please review your application carefully and verify all information is accurate before submitting.

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General Information
Primary Applicant
Co-Applicant
Signature
Submit Application