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Visa Debit Card Application

If you are here, it must mean that you have decided to apply for a Credit Union VISA Debit Card. In order to apply for a VISA Debit Card, you must be a member, in good standing and have a checking account at the Credit Union. You can get started by filling in the information below. When the information below is received at the Credit Union, it will be transferred to a VISA Debit Card Application. A Member Service Representative will then mail you the VISA Debit Card Application requesting that you fill in any additional information that is necessary and sign the VISA Debit Card Application. The mailing will also include the following required disclosure, Electronic Funds Transfer Agreement. Upon receiving the completed VISA Debit Card Application back from you, your application will be processed and a VISA Debit Card will be sent to you. You will activate your new VISA Debit Card by following the instructions on the Card.

Important: Each joint owner must fill out a separate application to receive a VISA Debit Card.

To complete this form online complete the form below and click the SUBMIT button

If you prefer, you may print this page with the form and then either fax to your credit union at (860) 583-0743 or mail it to us with the following address:

25 North Street
P.O. Box 698
Bristol, CT 06011-0698

Online Application

* - Indicates required field

Account Information

I wish to access this account for Check Card and ATM use.