Business Debit Card Application
*Required Information
Primary Account Holder Information
*Business Name:
*Taxpayer ID #:
*Contact Person:
*Title of Business Owner
or Authorized Officer:
Corporation
Partnership
Sole Proprietorship
LLC
Other
For Profit
Not For Profit
*Business Address:
*City:
*State:
*Zip Code:
*Telephone:
*Fax Number:
*Email Address:
Please issue a Debit Card to the following authorized users as indicated on the Authorized User section of this application.
*
BUSINESS ACCOUNTS TO BE ACCESSED:
(ATM & Visa Transactions)
I hereby certify that I am the owner or duly authorized officer or representative of the Business identified above and am authorized to bind the Business to this Agreement. The Business hereby requests that SECURITY NATIONAL BANK OF ENID (Bank) issue a Visa Business debit card (Card) to each of the individuals identified as Authorized Users in the Authorized User Information section of this application. The Business understands and hereby authorizes that each card so issued shall be used to access funds in the account(s) of the Business maintained at Bank either through an ATM or at a Visa point of sale terminal. The business hereby authorizes and ratifies all transactions performed on the accounts of the Business by an Authorized User identified in the Authorized User Information section. The Business further hereby unconditionally indemnifies and holds harmless Bank and its representatives from any and all claims, damages or expenses of whatever nature asserted against Bank or its representatives by virtue of the issuance of a Card as authorized herein or the use of a Card or a transaction using a Card by an Authorized User on an account maintained by the Business with Bank. I acknowledge receipt of the
“Visa Liability Waiver Program Guide”
and agree to notify the Bank in writing upon the termination of an Authorized User or upon revocation of this Authorization and will provide the Bank with reasonable time to act upon such notification. By signing below, if approved, the Business and all Authorized Users agree to the terms of the Business Debit Card Agreement Terms and Conditions and other Depository Agreements and Disclosures as applicable to Business Accounts. Business and Authorized Users do hereby authorize Bank to obtain their business and personal credit history.
AUTHORIZED USER INFORMATION
*Authorized User:
*Date of Birth:
*Social Security Number:
Home Address:
For Internal Use Only (card mailed to business)
*Dollar Limit $:
(may not exceed $2,500/day)
*ATM cash withdrawal authorized?:
(may not exceed $1,005.00 per day)
Yes
No
For internal use: Card Number: ___________________ Card Offset: ___________________
Check here to add additional Authorized Users
Authorized User:
Date of Birth:
Social Security Number:
Home Address:
For Internal Use Only (card mailed to business)
Dollar Limit $:
(may not exceed $2,500/day)
ATM cash withdrawal authorized?:
(may not exceed $1,005.00 per day)
Yes
No
For internal use: Card Number: ___________________ Card Offset: ___________________
Check here to add additional Authorized Users
Authorized User:
Date of Birth:
Social Security Number:
Home Address:
For Internal Use Only (card mailed to business)
Dollar Limit $:
(may not exceed $2,500/day)
ATM cash withdrawal authorized?:
(may not exceed $1,005.00 per day)
Yes
No
For internal use: Card Number: ___________________ Card Offset: ___________________
Issuance of Cards:
Bank will issue Cards in the name of the Business and in the name of the Employees as designated. Usage of the cards will be limited to debits only. No deposits may be made using the Cards. All Cards must be signed immediately upon receipt by the Employees, but all Cards remain the property of Bank and must be surrendered to Bank upon demand. Business acknowledges the Bank is providing such service to Business as an accommodation party only and, except as otherwise provided by law, Bank is not responsible in any way for the manner in which the Cards are utilized.
Bank requires that each Employee have a Personal Identification Number (PIN).
I have read and agree to the
Terms and Conditions