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ATM Card / MasterMoney™ Card Application |
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DEPOSITOR INFORMATION |
JOINT DEPOSITOR INFORMATION |
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Applicant |
Co-Applicant |
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Social Security |
Social Security |
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Street Address |
Street Address |
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City |
City |
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State & Zip Code |
State & Zip Code |
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Home Phone |
Home Phone |
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Work Phone |
Work Phone |
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Have we issued an ATM Card to youNo Yes |
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| If yes, please check one: Close this account Keep this account open | ||||
| ACCOUNT INFORMATION and APPLICANT(S) AUTHORIZATION | ||||
I/We would like to access the following account(s) with my/our: |
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Checking (Required for MasterMoney™ Card) |
Savings Account |
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Primary Account Number |
Primary Account Number |
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Other Account Number |
Other Account Number |
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| SIGNATURES | ||||
| By signing below, the undersigned request(s) the described services and agrees to the terms and conditions governing the services, including any fees and charges. The undersigned agree(s) that all information is accurate and authorizes Kalamazoo County State Bank to verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency. | ||||
Applicant’s Signature X |
Date |
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Co-Applicant's Signature X |
Date |
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| The above signed request(s) that KCSB limit the total amount of cash that can
be withdrawn using an electronic funds transfer terminal in one day to $50.00. If you desire a different amount enter it here |
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Print and sign this application, then mail, fax or deliver it to the KCSB office where you maintain your accounts. |
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