Star One Credit Union
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Star One Visa Debit Card Application

If you prefer to submit this form electronically, log into Online Banking, click on the "Online Forms" tab, then select "Visa Debit Card Application."

Please complete, print, sign, date, and mail this application to Star One Credit Union, P.O. Box 3643, Sunnyvale, CA, 94088-3643, Attn: Card Services. You may also fax this form to (408) 543-5203 Attn: Card Services.

NOTE: A checking account is required to apply for a Visa Debit Card.

If you would like an ATM Card only, please contact Member Phone Services at (408) 543-5202 or (866) 543-5202.

First & Last Name Member Number
Address Daytime Phone ( )
City    
State    
Zip    

Please send a free Star One Visa Debit Card for me, and/or A Star One Visa Debit Card for my joint owner.

By signing this application I/we agree that I/we have read and agree to be bound by the terms and conditions of the Visa Debit Card Agreement and Disclosure Statement. I/we understand that the Visa Debit Card Agreement and Disclosure Statement will be mailed with my/our cards(s).

Check here if you want a computer generated Personal Identification Number (PIN).

If you would like to select your own PIN, please enter your five-digit PIN below (numbers only, no letters).

Primary Member's PIN       Joint Member's PIN


__________________________ __________
Member Signature Date
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