FSNB Debit Card Request
Please read before filling out this Debit Card request
Must be an account holder 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 $12 for the basic card design
-OR-
Select a custom image card from the Card Gallery for an additional fee of $12.00
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.
