ATM/Check Card Application
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ATM Card          Check Card
Primary Cardholder Information (Member)
 
*Name (First M. Last):
*Date of Birth (mm/dd/yyyy):
*Member Number:
*Social Security Number:
*Address:
*City, State Zip: ,
*Home Phone Number:
*Work Phone Number:
*Driver's License Number:       *State:
*E-Mail Address:
*Employer:
Secondary Cardholder Information (if applicable)
 
Name (First M. Last):
Date of Birth (mm/dd/yyyy):
Social Security Number:
Home Phone Number:
Work Phone Number:
Driver's License Number:       State:
E-Mail Address:
Employer:
ATM Card Disclosure

I (We) agree that the use of the Kinetic Credit Union ATM Card issued in response to this application will constitute my (our) agreement to be jointly and severally bound by the terms and conditions of the Membership/Lending Agreement Booklet. It is certified that the above information is complete and true, and is given to request you to issue said Card(s). I (We) authorize you to make whatever credit and/or investigative inquires deemed necessary in connection with this application and to exchange with others regarding my (our) Card transactions. I (We) understand that this Card is not a Credit Card, and that no commitment to extend credit to me (us) will be made by your issuance of the ATM Card(s) requested. I (We) understand that a secondary card will not be issued unless that person is joint owner on the savings and checking accounts of the primary member.

Check Card Disclosure

I (We) agree that the use of the Kinetic Credit Union Check Card(s)/Debit Card(s) issued in response to this application will constitute my (our) agreement to be jointly and severally bound by the terms and conditions of the Kinetic Credit Union Check Card(s)/Debit Card(s) Agreement delivered with the Card(s). It is certified that the above information is complete and true, and is given to request you to issue said Card(s). I (We) understand to receive a check card, enrollment in the Advantage or Freedom checking is required. I (We) understand that a secondary card(s) will not be issued unless that person is joint owner on the savings and checking accounts of the primary member. I (We) authorize you to make whatever credit and/or investigative inquires deemed necessary in connection with this application and to exchange with others regarding my (our) Card(s) transactions. I (We) understand that this Card(s) is not a Credit Card, and that no commitment to extend credit to me (us) will be made by your issuance of the Kinetic Credit Union Check Card(s)/Debit Card(s) requested.

I (We) aknowledge and agree to the terms and conditions as outlined above.

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