DEBIT CARD APPLICATION
  

Last Name:
First Name:
Middle Name:
Social Security Number:
Current Address:
City:
State:	TN
Zip:
How Long (Years):
Mailing Address (If different from above):
City:
State:
Zip:
Home Phone:
Previous Address:
City:
State:
Zip:
Business Phone:
Employed By:
Position:
How Long:
Annual Household Income:
Employers Address:
City:
State:
Zip:
Nearest Relative Not Living With You:
Address:
Credit Reference (if new checking account):
Bank Name:
Address:
Account Number:
PLEASE FILL IN THE PRIMARY CHECKING ACCOUNT NUMBER BELOW. THIS IS THE ACCOUNT THAT ALL PURCHASES WILL BE DEBITED FROM. IF YOU WANT TO INCLUDE YOUR MONEY MARKET SAVINGS OR ANY OTHER CHECKING ACCOUNTS FOR THE ATM, PLEASE ENTER THEM IN ANY ADDITIONAL ACCOUNTS BELOW.
People's Bank and Trust ATM Card # (last 7 digits): (If you currently have one, this one will close when new card arrives.
Primary Checking Account Number:
Primary Money Market Savings #:
PIN Number Selected:
ANY ADDITIONAL ACCOUNTS:  INCLUDE ACCOUNTS TO ACCESS THROUGH TELEPHONE BANKER
Type:	Account Number:
Type:	Account Number:
Type:	Account Number:
PLEASE READ BEFORE SIGNING I understand that this is not a credit card application. I have answered the questions in this application fully and truthfully, and all information provided is correct. I authorize you to obtain information to check my credit records and statements made in this application. I understand that if approved, cards will be mailed to the address listed on my People's Bank & Trust checking account. The use of such Card shall be governed by the printed terms and conditions of the THE AUTOMATED TELLER MACHINE CARDHOLDER AGREEMENT and such other terms and conditions or amendments thereto, as may be established by People's Bank & Trust and communicated in writing to me.