Name of Cardholder:  * Cardholder SSN(Last 4):  * FSNB Account # card is used for: Daytime Phone #:  *

What happened to your card? : -- Choose Card Status -- Lost Stolen Compromised Damaged Card Not Working I have never had a card  * Date your card was Lost, Stolen, Compromised, Damaged, or stopped working:  * Are there any unauthorized transactions on your card? : -- Answer Required -- Yes No  * Would you like a new card? : -- Answer Required -- Yes No  *

Do you agree to pay the $12 Card Replacement Fee? : Yes No    (Account will be charged)

Would you like any reoccurring merchants to have access to the new card information? : -- Answer Required -- Yes No     What is this?

Visa offers a service that will allow merchants that charge your card based on billing cycles, the ability to obtain new card information. This may eliminate the need for you to contact individual merchants to update your payment methods. Please note that FSNB, N.A. has no control over which merchants participate in this program.

Would you like to choose a custom image from our card gallery for an additional $9.50? : Yes No

Please select your custom card image : Beach Cat Dog Dollar Sign Dolphin Dragon Eagle Fashion Flowers Flying Eagle Gaming Hocus Pocus Mother Never Give Up Pets Space Sports Unicorn Wild Horses

Do you want your new card sent using Expedited Mail? : Yes No

What method of delivery would you like your new card sent? : -- Answer Required -- Regular Mail Priority Mail Overnight Delivery  *

Requests received prior to 12:00 p.m. CST will be
processed the same business day, all other requests
will be processed on the following business day.

Do you agree to pay the $25 Expedited Mail Fee? : Yes No    (Account will be charged)

Due to COVID-19 and Fed Ex Staffing and/or different
State orders, Fed Ex is not able to guarantee next day
delivery. All requests for overnight delivery will be processed
and all fees will apply, regardless of when the package is delivered.

If your request requires Saturday Fed Ex delivery,
there is an additional charge of $15.

If applicable, do you desire to have Saturday delivery for an additional $15 fee? : -- Answer Required -- Yes No    (Account will be charged)

You can expect to receive your new card through normal US mail processing time. Address Line 1:  * Address Line 2: City:  * State: -- Answer Required -- ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING AA - MILITARY AMERICAS AE - MILITARY EUROPE AP - MILITARY PACIFIC AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM MARSHALL ISLANDS NORTHERN MARIANA ISLANDS PALAU PUERTO RICO VIRGIN ISLANDS  * Zip Code:  *

Requests received prior to 12:00 p.m. CST will be
processed the same business day, all other requests
will be processed on the following business day.

Do you agree to pay the $10.00 Expedited Mail Fee? : Yes No    (Account will be charged)

You can expect to receive your new card through normal priority mail processing time. Address Line 1:  * Address Line 2: City:  * State: -- Answer Required -- ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING AA - MILITARY AMERICAS AE - MILITARY EUROPE AP - MILITARY PACIFIC AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM MARSHALL ISLANDS NORTHERN MARIANA ISLANDS PALAU PUERTO RICO VIRGIN ISLANDS  * Zip Code:  *

Do you agree to pay the $35.00 Expedited Mail Fee? : Yes No    (Account will be charged)

Due to COVID-19 and Fed Ex Staffing and/or different
State orders, Fed Ex is not able to guarantee next day
delivery. All requests for overnight delivery will be processed
and all fees will apply, regardless of when the package is delivered.

If applicable, do you desire to have Saturday delivery for an additional $15 fee? : -- Answer Required -- Yes No    (Account will be charged)

Your account will only be charged the total of $50 if Saturday delivery is applicable to the date of your request.

Address Line 1:  * Address Line 2: City:  * State: -- Answer Required -- ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING AA - MILITARY AMERICAS AE - MILITARY EUROPE AP - MILITARY PACIFIC AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM MARSHALL ISLANDS NORTHERN MARIANA ISLANDS PALAU PUERTO RICO VIRGIN ISLANDS  * Zip Code:  *

Address Line 1 (US Addresses Only):  * Address Line 2: City:  * State:  * Zip Code:  *

Do you want your PIN sent to the same address
as your expedited card? : Yes No

Address Line 1:  * Address Line 2: City:  * State:  * Zip Code:  *

You have stated that you have unauthorized transactions, please select Debit Card Services inside online banking and complete the FSNB Card Dispute form. The completed form should be submitted within 10 business days.

To select a Personal Identification Number (PIN) for your new card, please visit a local branch in your area or call our IVR-Private Access System at 1-800-355-2140 and select Debit Card Services.

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