Horizons Federal Credit Union
ATM Card Request Form

To request an ATM Card, simply print this form and a PIN request form, click here complete both forms and mail them to:
Horizons Federal Credit Union
P.O. Box 1881
Binghamton, NY 13902

[] New Card

[] Replacement Reason________________

[] Lost/Stolen *Needs to be blocked immediately

Account Number:________________________________________________________________

Name(s) to be shown:___________________________________________________________
on card(s) (only one name per card
_______________________________________________________________________________

Address:_______________________________________________________________________

_______________________________________________________________________________

Daytime Phone #:_________________________Home Phone #:_________________________

Do you have full pay direct deposit into this credit union? Yes_______ No______

If yes, deposit is made from:__________________________________________________

I understand that:
My account will be charged $5.00 for each card (1 card for each name listed above). If I have full-pay direct deposit or a checking account, I will receive one card free-of-charge, one time only.

I will be charged $1.00 for each balance inquiry at automated teller machines or point of banking locations, and $0.75 for each withdrawal in excess of the 6 free withdrawals allowed per month. *Additional fees charged by the ATM owners may be assessed and beyond the control of this credit union.

I agree to abide by the provisions of the cardholder agreement.

            Signature(s)__________________________

                              __________________________

            Date_______________________________

The credit union reserves the right to refuse this request to any unqualified applicant.

8 Ways to reduce ATM fraud:

1. Memorize your Personal Identification Number (PIN).  Never write it on your ATM card or card envelope.

2. Don't discuss your account balance with anyone.  Never give information on your account or PIN over the phone.

3.  Never allow anyone to use your card or PIN.

4.  Don't withdraw money for an "official person".  No credit union or bank representative, auditor, or law enforcement person will ever ask you to withdraw money from an ATM for any reason.

5.  Keep your receipts and verify each transaction on your statement.  If you have an unexplained transaction, contact your financial institution immediately.

6.  Report lost or stolen cards or ATM crimes to your financial institution or police immediately.

7.  Carefully read the Electronic Funds Transfer agreement and disclosure you receive from your financial institution.  Know your liability for failing to notify your financial institution in a timely manner of a lost or stolen card.

8.  Cancel your ATM transaction and return at a later time if you notice anything suspicious.

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More about the Horizons FCU ATM/Credit/Debit card

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