VISA® Debit Card Application

Please follow these instructions:
  1. Completely fill out this form.
  2. Follow the TELEPIN instructions to select your PIN
  3. Print the form by pressing the print button.
  4. Sign the form.
  5. Bring the form into any one of our branches OR mail the form to:

    South Florida Educational Federal Credit Union
    7800 SW 117th Avenue
    Miami, Florida 33183
General Information

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Joint Information

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VISA® Debit Card Information

New   Add Joint   Pin# Change   Account# Change   Name Change

TELEPIN Instructions
Please call the TELEPIN® service at 800-442-3387 and use Client ID # 51039 to securely select your own Personal Identification Number (PIN) for this card.

Your call will be answered by an automated system that will assign a unique 6 digit TELEPIN® ID to you which must be written in the space indicated below. Please be sure to write clearly and accurately. Incorrect or missing TELEPIN® IDs will cause your PIN to be other than the one you selected.

You may use the same TELEPIN® ID for the primary and joint cards if they are being requested on the same application and you wish to have the same PIN for both cards. If you wish to have separate PINs for the cards you will need to make a separate call to get a TELEPIN® ID # for the joint. If you are adding a joint card you must also call for a new TELEPIN® ID # for the joint.

Record your TELEPIN® ID# here:

I hereby make application for VISA® Debit Card and agree to the terms and conditions set forth in the Electronic Funds Transfer Disclosure relating to the use of my card(s). I AGREE NOT TO GIVE ANY PERSON MY PERSONAL IDENTIFICATION NUMBER (PIN) NOR KEEP MY CARD AND PIN NUMBER IN THE SAME LOCATION. I understand that I will be liable in accordance with the disclosure and that the use of my card(s) and PIN number will give access to my savings and checking account.

Pin selection should not be any of the following: Birthday, S.S #, address, telephone, same numbers or obvious numbers such as 1234. You should memorize your PIN # and destroy any paper which contains it.

Primary Signature ____________________________________    Date _________________

Joint Signature ______________________________________     Date _________________

Do not write below this line / CU use only
Primary Member Identification: ________________________ (i.e. drivers lic., passport, etc.)

Joint Member Identification: ___________________________ (i.e., drivers lic., passport, etc.)

Former Acct# (if applicable) _____________    Former Name (if applicable) __________________________

Comments: _____________________________________________________________________________

Comments: _____________________________________________________________________________

SFEFCU Rep: _________________________
rev 04/2006
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