Debit Card Application

In order to apply for a debit card for your account, please complete the form below. If your card has been lost or stolen, or if you have any questions about completing the application, please call our service center at (800)342-0679.

Required Field

General

Card Type

New Card
Replacement Card

16 Digit Card Number

Applicant

First Name Middle Initial Last Name Suffix Name of Business Social Security Number Mailing Address City State Zip Code Home Phone Number Cell Phone Number Work Phone Number E-mail Address

Linked Accounts

Checking Account Number Savings Account Number

Authorization

By my signature below, I am requesting a TrustTexas Bank, SSB Debit Card. I understand that my Debit Card will allow access to my bank accounts listed above. I understand to memorize my Personal Identification Number (PIN) and not to write the PIN where it can be stolen or lost with my Debit Card. I have received a copy of the liability disclosures concerning the use of my Debit Card. The Bank may obtain a current credit report upon receipt of this application. I agree to abide by the regulation terms and conditions established by TrustTexas Bank, SSB as related to the use of the Debit Card.

Yes, I agree to the Terms and Conditions. Signature Date