DEBIT CARD APPLICATION

To apply for The Citizens Bank Debit Card, you must do so in person at one of our local branch locations. We have made the application available here if you want to fill it out ahead of time. When finished, simply select PRINT at the bottom of the form and bring the signed and printed form into your local branch for further assistance.

Checking Account Number:

Applicant's First Name:

Middle Name:

Last Name:

Address:

City:

State:

Zip Code:

Home Phone Number:

Date of Birth:

/ /

Employer:

Length of employment:

Social Security Number:

E-Mail Address:

I am a Citizen of the United States of America.

Please issue an additional card

Co-Applicant's First Name:

Middle Name:

Last Name:

Home Phone Number:

Date of Birth:

/ /

Employer:

Social Security Number:

My Co-Applicant is a Citizen of the United States of America.

If you would like access to additional The Citizens Bank accounts (checking, money market or savings accounts) at ATMs, enter those account numbers below:

Account Numbers:

IMPORTANT STEP: Once you have filled out the form and are ready to bring it to your local branch for further assistance, print it and then sign and date it.