Home • Debit Card Application Leave me blank for Debit Card Application. *Required Field * Checking Account Number Email Address * First Name * Last Name Middle Initial * Primary Phone Number Business Phone Number * Last 4 Digits of SSN * Date of Birth Employer's Name * Is this card a reissue? Yes No * Reason for reissue: - Select Reason - -Select Reason - Lost Card Stolen Card Fraud on Card Name Change Damaged Card By pressing “submit” below, I agree that the use of any Debit Card (“card’) issued in response to this application will constitute my agreement to be bound by the terms and conditions set form in the EFT Disclosure agreements. I understand that I am the only individual authorized to use the card, that a PIN will be assigned to me, and that the card has a daily ATM and POS limit. I certify that the above information is complete and true, and is given to induce you to issue said card. I give the Bank permission to secure consumer and/or credit reports on me for use in connection with this account. I understand this card is not a credit card, and that no commitment to extend credit to me will be made by your issuance of the card requested. I understand a fee of $10 will be charged to by account for a reissued card. I acknowledge and agree to the terms and conditions as outlined above. There was an error submitting the form Thanks for contacting Colonial Federal Savings Bank We'll respond to your debit card request as soon as possible.