To submit this form, you can choose from several options: mail it to Chelsea Savings Bank at their designated address, fax it to their secure fax line, or submit it in person at a branch location. Ensure all fields are accurately filled out and signed before submitting. Advise: It's recommended to contact the bank directly to confirm their preferred submission method and obtain any additional instructions or details regarding your request.

Important dates for this form include issuance dates for new cards, replacement deadlines, and fraud report timelines. Be sure to check with Chelsea Savings Bank for specific dates relevant to your request. Stay informed to ensure timely processing of your form.

The purpose of the Chelsea Savings Bank Debit/ATM Card Application Form is to provide customers with a convenient way to apply for, modify, or manage their debit/ATM cards. Whether you are applying for a new card, requesting a replacement, or seeking a limit increase, this form captures all necessary information to ensure your request is processed accurately and efficiently. Additionally, this form allows customers to report lost, stolen, or fraudulent transactions, helping to protect their financial security. Accurately completing this form helps Chelsea Savings Bank deliver prompt and effective service, ensuring all your card-related needs are met. By gathering essential information, the bank can verify your identity, assess your request, and take appropriate actions to provide or modify your card services. By filling out and submitting this form, you give Chelsea Savings Bank the necessary authorization to process your request and ensure your debit/ATM card remains secure and functional.

• 1. Applicant: Full name of the individual applying for or making changes to the debit/ATM card.
• 2. Address: Residential address of the applicant, including city, state, and zip code.
• 3. Primary Phone: Primary contact number for the applicant.
• 4. Secondary Phone: Secondary contact number, if applicable.
• 5. SSN: Social Security Number of the applicant.
• 6. DOB: Date of Birth of the applicant.
• 7. Business Name: Name of the business, if the card is for a business account.
• 8. EIN: Employer Identification Number for business accounts.
• 9. Card Number: Existing card number if applicable.
• 10. Desired Services: Selection of services such as ATM card, debit card, new card, close card, replace card, etc.
• 11. Account Numbers: Attached account numbers for checking or savings accounts.
• 12. Limit Changes: Request for one-time or permanent daily withdrawal limit increase.
• 13. Replacement Card Number: Number of the replacement card if applicable.
• 14. Reason for Limit Change: Explanation for requesting a change in daily withdrawal limit.
• 15. Rush Order: Option for expedited card order with applicable fees.
• 16. Employee Requesting: Name of the bank employee processing the request.
• 17. Authorization: Signatures and dates to authorize the request.

Failure to submit this form may result in delays or inability to process your Debit/ATM card request. It is crucial to complete and submit the form accurately and promptly.

• Delayed Processing: Submitting the form late can delay the processing of your card request.
• Incomplete Application: Failure to provide complete and accurate information may prevent the bank from processing your request.
• Unresolved Issues: Not submitting the form may leave issues such as lost or fraudulent cards unresolved.

• 1. New Card Application: Use this form to apply for a new debit or ATM card.
• 2. Card Replacement: Submit this form to request a replacement for a lost or damaged card.
• 3. Limit Increase: Complete the form to request an increase in your daily withdrawal limit.
• 4. Fraudulent Activity: Report suspected fraud on your card by using this form.
• 5. Account Changes: Use this form to make changes to the accounts linked to your card.