Debit/ATM Card Reissue

Customer Information

  • OK First Name is required
  • OK Middle Initial is required
  • OK Last Name is required
  • OK Social Security Number is required
  • OK Date of Birth is required
  • OK Email is required
  • Optional OK Mother's Maiden Name is required

Address Information

  • OK Street is required
  • OK City is required
  • OK State is required
  • OK Zip is required
  • OK Home Phone is required
  • OK Work Phone is required

Card Information

  • OK Reason for Reissue is required
  • OK Last 4 digits of Current Debit/ ATM Card is required

    • Note: This is the number on the front of your card. If your card was destroyed, type "destroyed" here and we'll look up the number for you.

 

  • Optional OK Additional Comments is required

Security Code

  • OK is required

    By clicking submit below, I am applying for a Washington Savings Bank Debit or ATM Card. I understand the Debit Card is not a credit card and that the dollar amount of the purchases made with this card will be deducted from my Washington Savings Bank deposit account only. I authorize Washington Savings Bank to verify the information provided above and to request a credit report if necessary. The Washington Savings Bank Debit Card is available for qualified customers only. Other requirements may apply. I agree to be bound by the terms and conditions covered in the appropriate Disclosure Statement and Cardholder Agreement. I certify receipt of the Electronic Funds Transfer Disclosure found the online banking service.

    I certify receipt of the Electronic Funds Transfer Disclosure.

  • OK Type your name here as your signature is required
  • OK Mother's Maiden name or Account Code is required

    • This document is being secured using SSL encryption provided by your browser. Your information will be encrypted when using this form while in transit between your browser and Washington Savings Bank.