Fill - Free fillable DEBIT CARD APPLICATION VISA (Northwestern Connecticut Community College) PDF form

Received By ___________ Ordered By ___________ Date___________

84 Wadswo

rth St

reet

Hartford, CT 06106

860-522-5388

www.CSECr

editUnion.com

VISA

DEBIT CARD APPLICATION

Please complete and submit this application to any CSE branch location or mail to the address listed above. Retain attached Regulation E Disclosure

and VISA Debit Cardholder Agreement for your records. For a joint owner to receive a Card, he/she must be a joint owner on both the share and share

draft accounts.

MEMBER INFORMATION

Member Name:

Member Number:

Date of Birth:

Address:

Home Phone:

Cell Phone:

REQUEST FOR ADDITIONAL CARD(S) FOR JOINT OWNER

I r

equest

a VISA Debit Card for the following joint owner:

Joint Owner Name:

Social Security Number:

Date of Birth:

Address:

Home Phone:

Cell Phone:

ACKNOWLEDGMENT

Pleas

e send me, and any joint owner listed above, a CSE Credit Union VISA Debit Card. I have read the attached disclosure in

compliance with Regulation E and agree to all terms and conditions of the cardholder agreement.

I understand that point-of-sale (POS) transactions can only be made from my share draft (checking) account.

Joint Owner Signature Date

Member Signature Date

ConnecticutStateEmployeesCreditUnion

RegulationEDisclosureandVISADebitCardholderAgreemen t



1. Accepting this Agreement/Cardholder Signature: Use of your

CSE VISA Debit Card means you agree to all terms in this

Agreement. Please read this Agreement carefully and keep a copy

for your records. Immediately sign the signature panel on the back of

the card when you receive your Card.

2. Definitions: “You” and “your” mean each person who has signed the

CSE Credit Union request for a CSE VISA Debit Card or who uses

your CSE VISA Debit Card with your consent. “We”, “us”, “our”,

“CSE” and “Credit Union” mean Connecticut State Employees Credit

Union through which you applied and received your CSE VISA Debit

Card. “Account” means each and all of your Accounts with us for

which you may use your Card. “Card” means your CSE VISA Debit

card. “PIN” means your personal identification number. “ATM” means

an automated teller machine. “POS” means point of sale

transactions. POS transactions are all transactions except those

made at an ATM. “Transfer” means a withdrawal of money by the use

of your Card. “Transaction” means use of the Card or the Account

number on the Card, and a Personal Identification Number (PIN)

when required, to perform a transaction with the Card.

3. Membership: You must be a CSE Credit Union member and have

an open share draft Account. A Card may be issued to the member

and one share draft joint member. You understand that providing a

Card to your joint owner will give your joint owner access to funds in

your savings and checking Accounts.

4. Issuance of Card: You have requested that the Credit Union issue a

Card that can be used to access funds in your Account. You will be

able to select your own PIN. You agree to take all reasonable

precautions to ensure nobody learns your PIN. At no time will you

reveal or make available directly or indirectly your personal

identification number (PIN) to any person. If you disclose your PIN to

others, any use of the Card will be considered authorized. You also

agree not to write the PIN on the Card(s) issued to you.

5. Use of Card and Limitations: The Credit Union issues the Card for

your use only. You are responsible for all Transactions you make with

the Card or that you authorize another person to make with the Card.

Any loss or theft of the Card and/or PIN will be promptly reported.

You agree not to withdraw funds in excess of the available balance in

your Account. The Card is not a credit card and its issuance does not

permit you to obtain credit from the Credit Union by using the Card.

You may make only ten ATM withdrawals and fifteen POS

transactions, with an overall limit of 20 transactions, per day with your

Card.

6. Types of Transactions: You may use your Card for the following

types of transactions:

POS Transactions:

Withdrawing funds from your share draft (checking) account to pay

for goods and get “Cash Back” up to $1,000 depending upon the

retailers’ policies. All POS transactions will be charged against your

checking Account.

ATM Transactions:

 Withdrawing cash from your share draft (checking) Account or

your regular share Account (savings).

 Inquiring about balances in your share draft or regular share

Account.

 Transfers between your share and share draft Accounts.

Some of these services may not be available at all terminals. You

may authorize a merchant or other payee to make a one-time

electronic payment from your checking account using information

from your check to pay for purchases and pay bills.

7. Limitations on Amounts of Withdrawal: Assuming available funds

in your Account, the daily transaction limit for POS transactions is

$1,000. For ATM transactions, the daily transaction limit is $500. The

Credit Union reserves the right to increase your daily limits at any

time without prior notice. Federal regulations limit the number of

certain types of transfers and/or withdrawals you can make from your

savings to six (6) per calendar month. The types of transfers and

withdrawals that are limited are those requested by fax, telephone,

Internet, and pre-authorized transfers.

8. Fees: There is no fee for using your Card to make a purchase at a

merchant location. After three (3) free ATM transactions per month,

there will be a 75¢ charge for each withdrawal, transfer, or balance

inquiry when using your Card at an ATM. You may be charged a fee

by the ATM operator or any network used and you may be charged a

fee for a balance inquiry even if you do not complete a fund transfer.

The Credit Union will not increase these fees and charges unless we

provide you advance written notice in accordance with applicable

laws and regulations.

9. Use of Card for Illegal or Risky Transactions: It is your

responsibility to comply with all laws when using your Card. You

agree to hold us harmless for any damages or other liability arising

from transactions initiated by you for the purpose of conducting illegal

activity. We reserve the right to decline authorization of transactions

for activities that we believe may violate law or pose significant risk to

us or our members.

10. Preauthorized Payments: If you have told us in advance to make

regular payments out of your Account, you can stop any of these

payments. Call us at 860-522-5388 or write us at CSE Credit Union,

Debit Card Department, 84 Wadsworth St, Hartford, CT 06106, in

time for us to receive your request three (3) business days or more

before the payment is scheduled to be made. If you call, we may also

require you to put your request in writing and get it to us within 14

days after you call. You will be charged a stop payment fee as

outlined in our Truth-In-Savings disclosure.

If these regular payments may vary in amount, the person you are

going to pay will tell you, 10 days before each payment, when it will

be made and how much it will be. You may choose instead to get this

notice only when the payment would differ by more than a certain

amount from the previous payment, or when the amount would fall

outside certain limits you set.

If you order us to stop one of these payments three (3) business days

or more before the transfer is scheduled, and we do not do so, we will

be liable for your losses or damages.

11. Foreign Transactions: Purchases and cash advances made in

foreign currencies will be debited from your Account in U.S. dollars.

The exchange rate between the transaction currency and the billing

currency used for processing international transactions is a rate

selected by VISA from a range of rates available in wholesale

currency markets for the applicable central processing date, which

rate may vary from the rate VISA itself receives or the government-

mandated rate in effect for the applicable central processing date.

The exchange rate used on the processing date may differ from the

rate that would have been used on the purchase date or cardholder

statement posting date.

12. CSE Liability for Failure to Make Electronic Fund Transfers: If the

Credit Union does not complete a transfer to or from your Account on

time or in the correct amount according to our agreement with you,

the Credit Union is liable for losses or damages, except in the

following instances:

 If, through no fault of the Credit Union, you do not have sufficient

funds in your Account to make the transfer.

 If the ATM machine where you made the transfer does not have

enough cash.

 If the ATM or POS machine was not functioning properly and

you knew of the breakdown before you started the transaction.

 If circumstances beyond the control of the Credit Union (such as

flood or fire) prevent the transfer despite reasonable precautions

that have been taken.

 Any other exceptions listed in your agreement with the Credit

Union.

 If the Credit Union believes there is fraud or suspicious activity

on your account.

13. Documentation of Transaction: You can receive a receipt at the

time you make any transactions to or from your Account using your

Card. Please retain these receipts for your records. You will receive a

monthly statement of your share draft Account. You will receive a

monthly statement of your savings Account, unless there has been

no electronic activity in a particular month. In any case, you will

receive a savings Account statement at least quarterly.

14. Refusal to Honor Your Debit Card: You agree the Credit Union is

not responsible or liable for any merchant, financial institution, or

other party that refuses to honor your Card.

15. Ownership and Cancellation of the Debit Card: The Card is the

property of the Credit Union. The Credit Union has the right to cancel

your Card at any time with or without written notice to you. You may

cancel Card privileges by notification to us in writing and physically

surrendering the Card.

16. Disclosure of Information to Third Parties: We will disclose

information to third parties about your Account or the transfers you

make: i) where it is necessary for completing transfers, or ii) in order

to verify the existence and condition of your Account for a third party,

such as a credit bureau or merchant, or iii) in order to comply with

government agency or court orders, or iv) if you give us your written

permission.

17. Card Replacement Fee: If your Account is subject to a Card

Replacement Fee, a fee will be charged for each replacement card

that is issued to you for any reason.

18. Business Days: For purposes of these disclosures, Credit Union

business days are Monday through Friday from 9:30 AM to 4:00 PM,

exclusive of holidays.

19. Your Liability: Tell us AT ONCE if you believe your Card has been

lost or stolen, or if you believe that an electronic fund transfer has

been made without your permission using information from your

check. Telephoning is the best way of keeping your possible losses

down. You could lose all the money in your Account. If you tell us

within two (2) business days after you learn of the loss or theft of your

Card, you can lose no more than $50 if someone used your Card

without your permission.

If you do NOT tell us within two (2) business days after you learn of

the loss or theft of your Card, and we can prove we could have

stopped someone from using your Card without your permission if

you had told us, you could lose as much as $500.

Also, if your statement shows transfers that you did not make,

including those made by Card, code or other means, tell us at once. If

you do not tell us within 60 days after the statement was mailed to

you, you may not get back any money you lost after the 60 days if we

can prove that we could have stopped someone from taking the

money if you had told us in time. If a good reason (such as a long trip

or a hospital stay) kept you from telling us, we will extend the time

periods.

20. In Case of Errors or Questions About Your Electronic Transfers:

If you think that a statement of or a receipt for an electronic transfer is

wrong, or if you need more information about a transfer listed on the

statement or receipt, contact the Credit Union at once: (860) 522-

5388 or write to: Connecticut State Employees Credit Union, 84

Wadsworth St, Hartford, Connecticut 06106-1794. We must hear

from you no later than 60 days after we sent the FIRST statement on

which the problem or error appeared.

You should furnish:

 Your name and Account number.

 A description of the error or transfer you are unsure about,

explaining as clearly as you can why you believe it to be an error

or why you need more information.

 The dollar amount of the suspected error.

Should you contact us orally, you may be asked to send your

complaint or question in writing within 10 business days.

We will determine whether an error occurred within 10 business days

after we hear from you and will correct any error promptly. If we need

more time, however, we may take up to 45 days to investigate your

complaint or question. If we decide to do this, we will credit your Account

within 10 business days for the amount you think is in error, so that you

will have the use of the money during the time it takes us to complete our

investigation. However, if you are asked to put your questions in writing

and you do not do so within 10 business days, we may not be able to

credit your Account. For errors involving new accounts, point-of-sale, or

foreign-initiated transactions, we may take up to 90 days to investigate

your complaint or question. For new accounts, we may take up to 20

business days to credit your account for the amount you think is in error.

Should no error be found, a written explanation will be sent to you within

three (3) business days after the investigation is completed. You may ask

for copies of the documents that were used in the investigation.

21. Reporting Lost Cards or PINs or Unauthorized Use of Your

Debit Card: Telephoning is the best way to prevent losses or keep

them at a minimum. If you believe your Card has been lost or stolen,

call the Credit Union at: (860) 522-5388

Or immediately write to:

Connecticut State Employees Credit Union

Debit Card Department

84 Wadsworth St

Hartford, Connecticut 06106-1794

You should also call the number or write to the address listed above

if you believe a transfer has been made using the information from

your check without your permission. In some circumstances, when

you phone, you will be asked to follow up with a written account.

22. Nothing in this agreement shall annul, limit, or in any way modify any

other obligation or relationship you may have with the Credit Union

now, or hereafter.

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