Reorder Visa Debit Card

In order to request a replacement Visa Debit card for your account, please complete and submit the form below. If your card has been lost or stolen, or if you have any questions about completing this application, please contact our Call Center at 1-800-860-1238.

Required Field

General

Card Type Reason for Request

Applicant

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Checking Account Number Date of Last Deposit or Check Card Tran Amount of Last Deposit or Check Card Tran Driver’s License Number or ID Number Mailing Address City State Zip Code

How would you prefer to be contacted if we need to validate any information received in this application?

Home Phone
Cell Phone

Phone Number E-mail Address Please do NOT email me important news and updates.

Authorization

By clicking the "I Agree" box below, the applicant requests the described services and agrees to the terms and conditions governing the services, including any fees and charges. The applicant agrees that all information provided is accurate and authorizes First Federal Bank of Louisiana to order the card type selected above and assess the $8 Replacement Card Fee, if applicable, to the Checking Account Number provided in the application. Check the "I Agree" box below to indicate that you, the applicant, have read the Electronic Funds Transfer Act Agreement and accept its terms.

Yes, I agree to the terms of the Electronic Funds Transfer Act Agreement.