ATM / Debit Card Application

ATM Cards are for Savings, Checking, or Money Market Accounts.
To be issued a Debit Card, you must have a Checking Account.
A Debit Card also doubles as an ATM Card.

For more information about Debit and ATM cards, click here.
Click for HHCU's Privacy Policy.

You may submit this application electronically, or you may fill it out, print it, and mail it to:
Hoosier Hills Credit Union
630 Lincoln Avenue
Bedford, IN 47452

Applicant*:	SSN*:
Co-Applicant:	SSN:
Street Address*:	City, State, Zip*:
Home Phone*:	Business Phone:
Employer:	Member Account Number*:
Choose One: New Card Replacement Card PIN Only
Choose One: Debit / ATM ATM Only Overdraft Line of Credit
I wish to withdraw money from my: (check all that apply) Savings Account Checking Account Money Market Account
I hereby apply for the service indicated above. I understand a disclosure statement will be provided to me and I agree to the terms of the Electronic Funds Disclosure. I authorize the credit union to make any credit inquiries or other investigations it deems necessary in connection with this application on the extension of credit.
Signature _____________________________________________ Date _________________
Signature _____________________________________________ Date _________________

Credit Union Use Only: Approved: Yes No Daily Limits: $500 $1,000 $1,500 Line of Credit Limit _______________ Member Service # ______________ Initials ______ Initials of Preparer _________