Fill - Free fillable DEBIT CARD ATM CARD AUTHORIZED USER REQUEST and/or PDF form

Form 185 (08/20) © Pentagon Federal Credit Union, 2020

First Name:

_______________________________________________________________________________________

Middle Initial:

__________

Last Name:

____________________________________________________________________________

____________

How Name Should Appear On Card:

☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

10-Digit Account Number

________________________________________________

Email Address:

_____________________________________________________________________________________________________________________________

____

Mailing Address

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_____

Primary Phone Number

(Mobile Preferred)

___________________________________________________________

__________

Alternative Number:

___________________________________________________________

__________

x Signature

__________________________________________________________________________

___________

Date

_______________________________________________________

___________

By signing below, I request a card for myself and the individuals named below. By naming these individuals as cardholders, I

appoint them as my agents for use of the card. I am responsible for their actions regarding the use of the card and indemnify and

hold PenFed harmless from such use. I have read the attached Debit Card/ATM Card Agreement and consent to all of its provisions.

DEBIT CARD

ATM CARD

and/or

AUTHORIZED USER REQUEST

DISCLAIMERS: DebitCards are only available for an Access America, PenCheck Plus or PenCheck Net checking

accounts. Restrictions apply for student checking accounts. ATM Cards are only available for Regular Share

accounts and can only be used with a PIN at an ATM. ATM Cards do not have Point of Sale access.

(19 Character Limit Including Spaces)

ADD or REMOVE AUTHORIZED USERS:

1. Add New Authorized User Remove Current Authorized User

First Name:

____________________________________________________________________________________

Middle Initial:

__________

Last Name:

_____________________________________________________________________________

_________

How Name Should Appear On Card:

☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

Date of Birth

(MM/DD/YYYY)

___________________________________________________

SSN/ITIN

____________________________________________________________________________

_________

_______

Check if ITIN

Primary Phone Number (Mobile Preferred)

__________________________________________________________

_______

Alternative Number:

__________________________________________________________

_______

Mailing Address

______________

____

(19 Character Limit Including Spaces)

2. Add New Authorized User Remove Current Authorized User

First Name:

____________________________________________________________________________________

Middle Initial:

__________

Last Name:

_____________________________________________________________________________

_________

How Name Should Appear On Card:

☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

Date of Birth

(MM/DD/YYYY)

___________________________________________________

SSN/ITIN

____________________________________________________________________________

_________

_______

Check if ITIN

Primary Phone Number (Mobile Preferred)

__________________________________________________________

_______

Alternative Number:

__________________________________________________________

_______

Mailing Address

______________

____

(19 Character Limit Including Spaces)

3. Add New Authorized User Remove Current Authorized User

First Name:

____________________________________________________________________________________

Middle Initial:

__________

Last Name:

_____________________________________________________________________________

_________

How Name Should Appear On Card:

☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

Date of Birth

(MM/DD/YYYY)

___________________________________________________

SSN/ITIN

____________________________________________________________________________

_________

_______

Check if ITIN

Primary Phone Number (Mobile Preferred)

__________________________________________________________

_______

Alternative Number:

__________________________________________________________

_______

Mailing Address

______________

____

(19 Character Limit Including Spaces)

For fast service, securely upload this form via PenFed.org/Upload.

Select Category > Cards Services and Document Type > Debit/ATM Card & Add/Delete Authorized User

Any person who accepts, signs, uses, or otherwise causes the

use of the Card or its account number or personal identiﬁcation

number (PIN) agrees to all the terms and conditions in this PenFed

Credit Union Cardholder Agreement, and any modiﬁcations that

may be made to the Agreement in the future.

General Provisions

The following provisions apply to the Pentagon Federal Credit

Union (PenFed) member and any person designated by the

member to receive a Debit Card or ATM Card (hereinafter

“Card”). The term “I” and “my” refers to the member and “we”

refers to the member and each cardholder.

Each person receiving or using the Card consents to all provisions

of the Debit/ATM Cardholder Agreement (“Agreement”). We

understand only the member may designate who may receive a

Card associated with the member’s accounts.

PenFed Member Provisions

I understand and agree:

I appoint those individuals I have authorized on the signature

card or by other method permitted by PenFed to receive a Card

or anyone else I authorize to use the Card, as my agent authorized

to access my accounts (checking, Money Market Savings or

Regular Share), as applicable (hereinafter “Accounts”), even

though such persons are not a joint owner or joint borrower.

The member shall provide each person receiving a Card a copy

of this Agreement and any amendments to it;

Use of the Card and PIN will allow each cardholder to transact

business on PenFed’s Automated Teller Machines (ATM) or other

PenFed-designated ATMs.

Use of the Debit Card (with or without a PIN) will permit the

cardholder to transact at eligible point-of-sale terminals or

locations. ATM Cards cannot be used at point-of-sale terminals.

I ratify all transactions initiated by any cardholder and indemnify

and hold PenFed harmless from such use.

The use of the Card and/or PIN and all transactions related to

such use are subject to all of the terms and provisions of present

or future share and loan account agreements as well as all

other PenFed policies, all of which are subject to modiﬁcation.

Said policies, terms and provisions are incorporated into

this Agreement by reference. In case of a conﬂict between

this Agreement and other agreements or policies in matters

pertaining to use of the Card, the terms and conditions of this

Agreement shall apply. We agree that PenFed shall have the

right to establish additional terms and conditions for use of the

Card, all of which shall be binding upon any cardholder following

written notice provided to the member, mailed to the last known

address of the member.

We shall be liable with respect to all authorized and unauthorized

transactions in accordance with this Agreement and applicable

laws and regulations.

Purchases or withdrawals made in foreign countries and foreign

currencies will be debited in U.S. dollars. The exchange rate for

international transactions will be a rate selected by Visa from the

range of rates available in wholesale currency markets, which

may vary from the rate Visa itself receives, or the government-

mandated rate in eect for the applicable central processing

date, plus a fee of up to 2% of the transaction amount. If the

purchase or withdrawal is initiated without the use of the PIN,

the applicable Visa rate will apply. The applicable ATM network

rate will apply for ATM transactions.

PenFed is authorized to obtain information, including a credit

report, concerning persons receiving a Card, as deemed

necessary in its sole discretion, to evaluate the eligibility and for

review of continued eligibility for a Card.

We agree to make a good-faith eort to resolve disputes

regarding goods or services obtained from the merchant. We

further agree, that PenFed shall not be liable for any claims we

have against a merchant arising from use of the Card for point-

of-sale transactions.

This Agreement, and all related matters, shall be governed by

and interpreted in accordance with the laws of the United States

and the Commonwealth of Virginia.

I agree to abide by the terms, conditions, and liabilities set forth

in the Electronic Fund Transfers Disclosure.

Cardholder Provisions

The following provisions apply to each person receiving or using

the Card and/or a PIN, including the member:

We agree the issuance of a Card and/or PIN is solely for our

individual use. We agree the Card and/or PIN will not be

divulged, given, or made available to any other person under

any circumstance.

We understand and recognize the use of the Card is governed by

this Agreement and any amendments to it.

We understand the member may revoke any cardholder’s

privilege to have access to the member’s Accounts using the

Card by notifying PenFed. Further, PenFed has no obligation

to inform the cardholder that access has been terminated. A

cardholder may cancel their Card by calling PenFed at 800-247-

5626.

We waive any right to stop payment on point-of-sale

authorizations originated by use of the Card and/or the PIN.

A withdrawal or authorized point-of-sale transaction will be

paid, even if it overdraws my Account or exceeds the OLOC

or TCS credit limit, if applicable. The order of posting debits,

charges, deposits or credits to any Account shall be established

at PenFed’s sole discretion and is subject to change.

We agree to immediately report to PenFed the loss or theft

of the Card and/or PIN or unauthorized transactions that have

occurred.

We understand and agree PenFed is not responsible for the

refusal by merchant or ﬁnancial institution to honor the Card.

We agree all point-of-sale adjustments may be made by credit

to my checking account by a properly executed credit voucher

issued by the appropriate merchant.

We agree the Card is the property of PenFed and we will surrender

it to PenFed upon request at any time and for any reason. We

understand the Card can be impounded automatically at the

ATM or by a merchant. We further agree PenFed shall have no

liability should a Card be seized due to malfunction or failure

of equipment or computer programs, or for security purposes.

We understand PenFed may revoke the use of the Card and/or

PIN if any of the member’s Accounts related to the Card’s use

are maintained in a manner that, in PenFed’s sole discretion, it

deems contrary to sound ﬁnancial practices.

We agree illegal use of the Card will be deemed an action of

default and/or breach of contract and the Card and other related

services may be terminated at PenFed’s discretion. We further

agree, should illegal use occur, to waive any right to sue PenFed

for such illegal use or activity directly or indirectly related to

it, and additionally we agree to indemnify and hold PenFed

harmless from suits or other legal action or liability, directly or

indirectly, resulting from such illegal use.

DEBIT/ATM CARDHOLDER AGREEMENT

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