Welcome to our online Debit card application. Before proceeding, please provide us with the following information so we can initialize your application.

Personal Information
Account Number  
Member Name  
Joint Member Name
Social Security Number  
Social Security Number (Joint)
Home address  
City  
State
Zip  
Home Phone  
Business Phone
Email Address
Requested Number of Cards
Signature (Member)  
Signature (Joint)

My/Our signature(s) above indicate that I/we hereby apply for REGIONAL federal credit union’s check card. Each use of the check card shall be deemed to be written authorization to change or credit my/our account(s) for the amount and the transaction indicated at the time of use. Each use also shall be deemed as my/our agreement to the terms of Electronic Funds Transfer Agreement. I/We also authorize the credit union to check my/our credit employment history from time to time as deemed necessary, and for the credit union to answer questions from others about the credit experience with me/us.

Yes, I want a checking account at REGIONAL.

Switch Kit: need help changing your accounts to REGIONAL? Fill out and print our free online Switch Kit and send to: Member Service Advisor, 2801 Boilermaker Ct., Valparaiso, IN 46383

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