FSNB Debit Card Request
Please read before filling out this Debit Card request
Must be an account holder (cannot be a minor) to apply for the Debit Card.
Power of Attorneys are not honored for the account holder.
Personal Information
First Name
*
Middle Initial
Last Name
*
Social Security Number
*
Date of Birth
*
Choose an Account Type
*
Checking
Savings
Account #
*
Email
Home/Cell Phone
*
Street Address
*
What happened to your card?
*
Please Choose
Lost
Stolen
Damaged
Compromised
Date your card was Lost, Stolen, Damaged or Compromised
*
Are there any unauthorized transactions on your card?
*
Please Choose
Yes
No
Uncertain
Card replacement fee will be $10 for the basic card design
-OR-
Select a custom image card from the Card Gallery for an additional fee of $9.50
Card Gallery
Standard-no additional fee
Dolphin
Dogs
Eagle
Fashion
Flowers
Sports
Would you like any reoccurring merchants to have accss to the new card information?
*
Select
Yes
No
Do you want your new card sent using Expedited Mail for an additional $35 fee?
*
Select
Yes
No
If applicable, do you desire to have Saturday delivery for an additional $15 fee?
*
Select
Yes
No
Your account will only be charged the total of $50 if Saturday delivery is applicable to the date of your request.
Signature
*
Date: *
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 day.
Please print, sign and return to:
FSNB, NA
Cards Department
P.O. Box 33009, Fort Sill, OK. 73503-3009
For Bank Use Only:
Approved by:
Date
Fields marked with an * (asterisk) are required.
