Check Card Application


How to submit your Check Card request:

1. Complete all fields of the application
2. Print the application on your printer
3. Submit your application either by:
  • Mailing your application to P.O. Box 3339, Tulsa, OK. 74101-3339 Attn:
    Transfund Clerk
  • Faxing your application to (918)-481-3088
  • Bringing your application into one of our locations

Primary Cardholder Information
Checking Account Number
  
First Name
  
Last Name
  
e-mail Address
  
Street Address
  
City, State
 ,  
Zip-Plus 4
-
Social Security #
  
Date of Birth (mm/dd/yy)
  
Home Phone Number
  -
Employer
  
Are you a US citizen?  yes     no

Secondary Cardholder Information
Please issue an additional card in the name of :
Checking Account Number
First Name
Last Name
e-mail Address
Street Address
City, State ,  
Zip-Plus 4 -
Social Security #
Date of Birth (mm/dd/yy)  
Home Phone Number  -
Employer  
Are you a US citizen?  yes     no
I/we agree that the use of any Check Card ("Card") issued in response to this application will constitute my/our agreement to be jointly and separately bound by the terms and conditions of the Check Card Agreement delivered with the Card. I/we certify that the above information is complete and true, and is provided for the sole purpose of obtaining the Card(s). I/we authorize American Bank and Trust to make whatever credit and/or investigative inquires deemed necessary in connection with this application. I/we understand that this Card is not a Credit Card, and that no commitment to extend credit to me (us) will be made by your issuance of the Check Card(s) requested.
 I (We) acknowledge and agree to the terms and conditions as outlined above.


Signature :____________________________________________