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VISA Debit Card Request Form

* Required Fields

This form is for OUCU members who already have a checking account and would like to open a Visa Debit card.

When you have completed the form, press the SUBMIT button to send your application for processing. If you have any questions, please call the Membership Services department at (740) 597-2800 or (800) 562-8420 during regular business hours.

This Account will be:

Individual

Joint

I am requesting a:

Regular VISA Debit card

Primary Owner Information

First Name:

Last Name:

Address:

Address 2:

City:

State:

ZIP:

Home Phone Number:

Work Phone Number:

Social Security Number:

Date of Birth:

/ /

Credit Union Account Number:

Email Address:

Joint Owner Information

(for an additional card for the joint owner)