VISA CheckCard Application

* indicates required field

VISA Checkcard for: *

Personal

Business

Select card type: *

AVB Visa CheckCard

AVB ATM card

Account Name*

Cardholder 1 Name*

Cardholder 2 Name

Address*

City*

State*

Zip*

Email Address 1*

Email Address 2

Checking Account Number (Last 4 digits)*

Accounts other than your primary checking can be tied to your ATM or CheckCard and accessible at full-service Transfund devices only.

Additional Account (Last 4 digits)

Account Type

Additional Account (Last 4 digits)

Account Type

ALL APPLICATIONS ARE SUBJECT TO APPROVAL.

Your Personal Identification Number (PIN) will be the last four digits of your social security number. Your card will be mailed to you. It has been suggested by AVB that I change my PIN, memorize it, never write it on my Card(s), and never tell anyone my PIN except people who are authorized to sign on my account, and even then disclosure is at my discretion.

AVB VISA CHECKCARD ELECTRONIC FUNDS TRANSFER AGREEMENT

I have received and read the disclosures concerning the use of my Card(s).

Business Account Information

Business Legal Name
(Name under which taxes are filed)*

Business TIN* (Last 4 digits)

Business Address*

City*

State*

Zip*

Email Address*

Type of Business*

Authorized User* (Must Be On Signature Card and Resolution)

Title

Authorized User (Must Be On Signature Card and Resolution)

Title

Authorized User (Must Be On Signature Card and Resolution)

Title

Authorized User (Must Be On Signature Card and Resolution)

Title

Business Accounts to be Accessed

Primary Business Checking Account# (Last 4 digits)*
(Account for Point of Sale Transactions)

Additional Checking Account# (Last 4 digits)

Savings Account# (Last 4 digits)

Additional Savings Account# (Last 4 digits)

ALL APPLICATIONS ARE SUBJECT TO APPROVAL.

Your Personal Identification Number (PIN) and card will be mailed to you separately. It has been suggested by AVB that I memorize my PIN, never write it on my Card(s), and never tell anyone my PIN except people who are authorized to sign on my account, and even then disclosure is at my discretion.

AVB VISA CHECKCARD ELECTRONIC FUNDS TRANSFER AGREEMENT

PIN will be mailed separately from card.

YOU MAY NOT USE THE VISA BUSINESS CHECKCARD FOR DEPOSIT TRANSACTIONS.

Address for lost or stolen cards, errors or questions, cancellation of card or account:
AVB
PO Box 130
Broken Arrow, OK 74103-9924
918.251.9611

The Accountholder(s) have requested the VISA Business CheckCard(s) as indicated and acknowledge receiving the BUSINESS CHECKCARD FUNDS TRANSFER AGREEMENT. If approved, the Accountholder(s) and all Authorized Users agree to the terms of the Agreement and Disclosures as applicable to AVB Business Accounts.

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