| ATM/VISA®Check Card Replacement | |||
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Name __________________________ Account # _______________________ Social Security # ___________________ (Check desired service.) _____ Card is damaged, worn, unreadable, etc. Need replacement card. _____ Card captured by ATM machine. Need replacement card. Date __________ Member Signature ______________________ Daytime Phone Number _________________ | |||
| Card Fees | |||
| Premier Member | Enhanced Member | Value Member | |
| ATM/VISA®Check Card Replacement | Free | $3 | $5 |
| Copy of PIN | Free | Free | $1 |
| ATM Withdrawals- Third party fees may also be charged. | 12 free per month $1 each thereafter. | 10 free per month $1 each thereafter. | 8 free per month $1 each thereafter. |