Debit Card Online Application

A Valley Bank debit card is an electronic checkbook you can use to buy goods and services worldwide, or use it as an ATM card to make deposits or withdrawals, transfer funds or check your balance.

* Required Field

Is this a reorder? *  Yes  No  

Applies to cardholders that want to reorder the same card number for an existing account. Note: There will be a $10 charge for all debit card reorders. This charge will be debited directly from your account.

Is this for a Health Savings Account?  Yes  No  
Would you like to choose your own PIN?  Yes  No  

Owner Information

 First Name: *
 M.I.:
 Last Name: *
 Social Security Number: *
 Date of Birth: (mm/dd/yyyy) *
- -

Co-Owner Information

 First Name:
 M.I.:
 Last Name:
 Social Security Number:
 Date of Birth: (mm/dd/yyyy)
- -

Additional Information

 Street Address *
 City *
 State *
 Zip *
 Phone *
 Checking Account Number *
 Savings Account Number