New Debit Card Application

Use this form if you are ordering a Debit Card for the first time. If you are requesting a debit card reissue, a name change, or additional cards, please submit a Debit Card Maintenance form. To report a lost or stolen debit card, please submit a Debit Card Lost/Stolen Report.

We value the security of your personal information. To be assured that the information you are sharing with us is protected by SSL data encryption, please make certain the web address starts with 'https'. Your browser may also show a 'lock' icon, indicating your information is secure.

Thank you for choosing PPCU. To begin your application please provide the following information.


Primary Account Holder Information:

* Account Number:
* First Name:
Middle Initial:
* Last Name:
* Email Address:
* Street Address:
Street Address 2:
* City:
* State:
* Zip:
* Daytime Phone:

I would like a debit card for my joint owner. NOTE: Joint owner must be listed on both the share and checking accounts.

Joint Owner 1:

First Name:
Middle Initial:
Last Name:

You must check this box in order to submit the application. By checking the box, you agree to the terms below:

I agree, by my use of PPCU's Debit Card service, to be bound by the terms and conditions contained in the Truth In Savings Disclosure.

I understand that my PIN # is not to be revealed to anyone, and is to be used only with the Debit Card. I agree that I am responsible for information obtained and all transactions performed with the use of my Debit Card.