Visa Check Card Application

This form must be completed, signed, and mailed or faxed to RVCCU.  The card and PIN will be mailed to the primary account holder at the address listed on the account.  You cannot request a specific PIN number using this method.  If you wish to request your PIN, please visit our lobby to complete this application.  Joint owner information and signature should only be provided if requesting cards for joint owners.

o Visa Check Card and PIN 
(You must have an open checking account and is subject to RVCCU approval.)

Date  ____________________                         Account #  ________________

Member Information

Name  _____________________________   Home Phone  ________________________

Address  ___________________________   Work Phone  _________________________

City  ____________  ST  ___  Zip  _______  Social Security #  _____________________

Joint Owner Information

Name  ______________________________  Name  _____________________________

Social Security #  _____________________   Social Security #  _____________________

By signing below, I understand and agree to the provisions of the Visa Check Card and ATM Card Agreement and Disclosure, Truth-in-Savings Rate and Fee Schedule, Funds Availability Disclosure and any amendment Roanoke Valley Federal Credit Union may make from time to time which are incorporated herein.  I also certify that I am the named owner of the above account and therefore have the right to request this service.

Signature  ______________________________________

Joint Owner Signature  ____________________________

Joint Owner Signature  ____________________________

Mail to:
Roanoke Valley Community CU
Attn:  Member Service
P. O. Box 13045
Roanoke, VA  24030

or Fax to:
(540) 982-3937