Visa Debit Card Application

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Form Instructions

Members with a checking account may apply for a Visa Debit Card, which can be used for purchases.

Members without a checking account may request an ATM card instead, which cannot be used for purchases. Please contact us for details.

To submit this form electronically, log into Online Banking and select "Visa Debit Card Application" in the "Forms" menu.

Please complete, print, sign, date and mail this application to:

Star One Credit Union
Attn: Card Services
P.O. Box 3643
Sunnyvale CA 94088-3643

You may also fax this form to (408) 543-5203 Attn: Card Services.

Your Information

Your Name:
Member Number:
Address:
Daytime Phone:
City:
State:
Zip:

Please send a free:

	Star One Visa Debit Card for me
	A Star One Visa Debit Card for my joint account owner

Check here if you want a computer-generated Personal Identification Number (PIN)

If you would like to select your own PIN, please enter your five-digit PIN below (numbers only, no letters).

Primary Member's PIN:
Joint Member's PIN:

By signing this application, I/we agree that I/we have read and agree to be bound by the terms and conditions of the Visa Debit Card Agreement and Disclosure Statement. I/we understand that the Visa Debit Card Agreement and Disclosure Statement will be mailed with my/our cards(s).

___________________________________________
Member Signature

_______________________
Date

Form Instructions

Your Information

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