Debit and ATM Card Application

In order to issue a personalized, individual card to each owner of a joint account, each owner must fill out a separate application.
*Indicates a required field

*Name(First M. Last):

*Social Security Number:

*Date of Birth(mm/dd/yyyy):

This address must match your records at SIS Bank. Cards will only be sent to known mailing addresses.


*City & State, Zip: ,

*Home Phone Number:

*E-Mail Address:

*I am a Citizen of the United State of America

*I wish to apply for a(n)

I wish to access the following accounts:

Primary Account(s):

Checking/Now Account #:

Statement Savings #:

Secondary Account(s)

Checking or Savings Account:

Checking or Savings Account:

*Are there any unsatisfied Judgments against you? Yes No

*Have you declared bankruptcy in the last 7 years? Yes No

Authorizations: By applying for an SIS Debit MasterCard or ATM Card as indicated above. I understand this is not a credit card and that the dollar amount of the purchases made with this card will be deducted from my Sanford Institution for Savings Checking/Now account only. The Debit MasterCard is available for qualified customers only. Other requirements apply. I agree to be bound by the terms and conditions covered in the appropriate Disclosure Statement and Cardholder Agreement

“I authorize Sanford Institution for Savings to make or have any credit, employment or investigative inquiry that it may determine appropriate for the issuance of a MasterMoney Debit or ATM Card or for the collection of amounts owed to it. Sanford Institution for Savings can furnish information concerning my account to consumer reporting agencies and others who may properly receive that information. If I ask I will be informed whether or not a consumer credit report was requested, and I will be informed of the name and address of the consumer reporting agency that furnished the report”

*I agree to the Authorizations stated above. (must check to submit)

Personal Identification Number (PIN)
This number belongs to you and is the key to the security of your accounts. Once entered in to our system, it is transformed and unavailable to anyone. If you forget your PIN or would like to change it, you must contact the Sanford Institution for Savings Customer Service Department.

To select your PIN, please choose four (4) numbers (using only numbers 0-9).

*Please enter your PIN number:
*Please Re-Enter Your PIN Number: