Application for the CSULA FCU Visa Debit/ATM Card

Note: If your Visa Debit/ATM card is about to expire, you will be mailed a replacement card approximately 1-2 weeks before your old card expires, you do not need to order a new card. If you are requesting a replacement card, or PIN, please note a fee may apply. See our Schedule of Fees and Charges.
To protect the confidentiality of personal financial information and signatures, California State University, Los Angeles Federal Credit Union requests that our members send applications via the following safe methods:
By Fax: Complete the information requested, then print out all pages of the application and fax to our secured number: 323-505-2613
By Mail: Complete the information requested, then print out all pages of the application and mail in a sealed envelope to Cal State L.A. Federal Credit Union Post Office: P.O. Box 1117, Montebello, CA 90640-1117
In Person: Bring the completed application to our office at the address above, and submit it confidentially to one of our specialists.

New Card Replacement Card & PIN (a fee may apply) Request for NEW PIN ONLY (a fee may apply)
         
Member Name
Account Number
.....
Daytime Phone Number
Home Phone Number
 		     
Address
 		Email
City
State
Zip
   
The CSULA FCU Visa Debit/ATM Card MUST access a CSULA FCU Share Draft Account. If you have more than one Share Draft Account, please specify which account to access.
Share Draft Account Number
   

If you would like your Visa Debit Card to access your existing CSULA FCU loan products, please contact the Credit Union.

By signing below, you acknowledge that you have received a copy of the Electronic Services Disclosure and Agreement and agree to the terms governing the services requested.


Member Signature:

X__________________________________ Date:_____________

Name to be on additional card - must be joint owner.

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