Debit / ATM Card Application with Design

Customer Information

  • OKFirst Name is required
  • OptionalOKMiddle Initial is required
  • OKLast Name is required
  • Social Security Number

    OKSocial Security Number is required
  • Date of Birth

    OKDate of Birth is required
  • OKEmail is required
  • OptionalOKMother's Maiden Name is required

Address Information

  • OKStreet is required
  • OKCity is required
  • OKState is required
  • OKZip is required
  • Home Phone

    OKHome Phone is required
  • Work Phone

    OKWork Phone is required

Account Information

    Please tell us the account number this card should access

  • OKPrimary is required
  • OptionalOKOther is required

Custom Debit Card Design

    Choose from one of our 85 designs
    and enter your design code below

  • OptionalOK is required
  • OptionalOKAdditional Comments is required

Security Code

  • OK is required

    By clicking submit below, I am applying for a Washington Savings Bank Debit or ATM Card. I understand the Debit Card is not a credit card and that the dollar amount of the purchases made with this card will be deducted from my Washington Savings Bank deposit account only. I authorize Washington Savings Bank to verify the information provided above and to request a credit report if necessary. The Washington Savings Bank Debit Card is available for qualified customers only. Other requirements may apply. I agree to be bound by the terms and conditions covered in the appropriate Disclosure Statement and Cardholder Agreement. I certify receipt of the Electronic Funds Transfer Disclosure found the online banking service.

    I certify receipt of the Electronic Funds Transfer Disclosure.

  • OKType your name here as your signature is required
  • OKMother's Maiden name or Account Code is required
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