PWSB Visa Check Card / ATM Card Application

Name #1:
Name #2:
City :
Zip Code :
PWSB Checking Account #:
Savings / Money Market Account #:
Purchases made with my Port Washington State Bank Visa Check Card will be deducted only from the checking account listed above.

I understand that if I or another account owner give a card and/or the confidential PIN to another person that they will be able to make withdrawals from the account or withdrawals for purchases from the account (and if I have a Personal Reserve Account, withdrawals may create loans for which I shall be responsible).

I agree that retention or use of the card will constitute acceptance of card rules which will be issued to me with the card.

NOTICE: If you are a party to a joint account, you appoint each other party as your attorney with power to appoint one or more agents with power to use the card to make withdrawals from such account, and each is individually and jointly responsible for any obligations incurred from use of the card, including use by any other person authorized by any of you.