MasterCard Debit Card Application




_______________________New MasterCard Debit Card        ________________Re-issue

                                                                                                                     ($10.00 charge)









Home phone_________________Work phone__________________________________


Date of Birth________________________SS#__________________________________


Checking acct#___________________________Savings acct#_____________________


_______Hot card card (List reason)___________________________________________

( A $10.00 fee will be assessed for ALL re-issued cards.)


I understand that this card is the property of The Trust Bank and must be surrendered on demand.  I also understand that I must NOT carry my PIN # with my card and that it is my responsibility to maintain the confidentiality of my PIN# to prevent any unauthorized withdrawals from my account.  Please see our disclosures for your liabilities when using the Master Money card.  The undersigned agrees that all information is accurate and authorizes the bank to verify credit history by any means necessary, including preparation of a credit report by a credit-reporting agency.







Bank use only


______________Approved        _____________Denied




New Card Number(s)