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General Credit Union
Application for a GCU ATM Card or Visa Debit Card

Applicant's Name:
SSN: Ex: 123-45-6789
DOB: Ex: MM-DD-YY
Co-Applicant's Name:
SSN: Ex: 123-45-6789
DOB: Ex: MM-DD-YY
Address:
City:
State:
ZIP:
Daytime Phone Number: --

You need to have $200 on deposit with General Credit Union in order to qualify for a General Credit Union card.

I would like a(n):
ATM Card
Visa Debit Card

If you currently have an account with General Credit Union, please fill in the applicable account number(s) you wish to use with your General Credit Union card.
Checking #:
Saving #:

If you do not currently have a General Credit Union checking or savings account and would like to open one, please mark the appropriate spot:
_____ I want to open a checking account.
_____ I want to open a savings account.
_____ Enclosed is my deposit.
_____ Transfer $_________ from savings
            account number ___________________

I hereby request that a General Credit Union card be issued, that such card be validated, and a Personal Identification Number (PIN) be issued for each card. I agree that the retention or use of such card(s) shall be governed by the printed terms and conditions of the General Credit Union cardholders agreement to be furnished upon card issuance.

Signature of applicant:____________________ Date:_______

Signature of co-applicant: _________________ Date:_______

   

Mail completed form to:
General Credit Union
6601 Mutual Drive
Fort Wayne, Indiana 46825


Each account is insured up to $250,000 by American Share Insurance.
By members' choice, this institution is not federally insured.
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