MBC

Debit or ATM Card Application

 
* Indicates fields that are required.
PERSONAL INFORMATION
*First Name:
Middle Initial:
*Last Name:
Suffix:
*Mailing Address:
*City:
*State:
*Zip Code:
*Email Address:
*Phone #:
Work Phone #:
IDENTITY VERIFICATION
*Social Security:
*Date of Birth:
*Last Deposit: $ on (date)
CARD INFORMATION - Cardholders must be authorized on account signature card.
Type of Card :
Personal Debit
HSA Debit
Business Debit
ATM (Cash Withdrawals Only)

Choose Card Background:
(Not available for ATM Card)

 

Waterfall Background
Lake
Green Field
Sunset
Waterfall
Lake
Green Field
Sunset

Name to Print on Primary Card:

Line #1

 

Line #2

 

Name to Print on Second Card:

Line #1

(For an additional card)

Line #2

 
*Accounts to Access with Card: # Checking Savings (Savings accounts only valid for ATM withdrawals.)
  # Checking Savings (Savings accounts only valid for ATM withdrawals.)
OVERDRAFT AUTHORIZATION
 I want Monticello Banking Company to authorize and pay overdrafts on my ATM and everyday debit card transactions. 

I do not want Monticello Banking Company to authorize and pay overdrafts on my ATM and everyday debit card transactions. If you do not authorize us to pay your overdrafts, your transaction will be declined. We pay overdrafts at our discretion, which
means we do not guarantee that we will always authorize and pay any type transaction. If we do not authorize and pay an overdraft,
your transaction will be declined. A fee of $28 will be assessed for paying transactions that result in an overdraft.
AUTHORIZATION
 I (We) have read the Terms and Conditions controlling the use of the ATM and ChekCard and agree that my (our) use of the 
ATM / ChekCard will be governed by those Terms and Conditions. It is further agreed that use of the ATM / ChekCard will be
governed by the Rules and Regulations of the card issuing institution, as amended from time to time, that are applicable to the
account indicated. I (We) acknowledge and agree that if I do not meet the eligibility requirements for a ChekCard, I (We) may
be eligible for, and if so, will receive an ATM Card.
  Please verify that all information is correct and click on the Submit button to submit your application for processing.

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FDIC EHL