Apply Now - Check Card or ATM Card

* = Required Field
 
Type of Card*:
 
Last Name*:
 First Name*:
 Middle:
Social Security Number*:
 Home Phone:
 Business Phone:
Current Address*:
 City*:
 State:
TN
  		Zip Code*:
Email Address*:
PLEASE FILL IN THE PRIMARY CHECKING ACCOUNT NUMBER BELOW. THIS IS THE ACCOUNT FROM WHICH ALL PURCHASES WILL BE DEBITED. IF YOU WANT TO INCLUDE YOUR MONEY MARKET SAVINGS OR ANY OTHER CHECKING ACCOUNTS FOR ATM WITHDRAWALS, PLEASE ENTER THEM IN ‘ADDITIONAL ACCOUNTS’ BELOW.
Wilson Bank and Trust ATM Card #:  (Last 7 Digits)
*If you currently have one. This one will be closed when new card arrives.
Primary Checking Account #: *
 
Primary Money Market Savings #:
ANY ADDITIONAL ACCOUNTS:
Type
Account #
PLEASE READ BEFORE SIGNING
I hereby request that an ATM or Visa Check Card be issued for the account owner designated above.  The retention or use of such Card(s) shall be governed by the printed terms and conditions of THE AUTOMATED TELLER MACHINE CARDHOLDER AGREEMENT and such other terms and conditions or amendments thereto, as may be established from time to time by Wilson Bank & Trust and communicated in writing to me.
Signature*:
Date*:
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