Reloadable (Everyday Spend) Cards

By signing my name below, I hereby authorize my Credit Union, Highway Crossroads Credit Union, to enroll me for a Everyday Spend Prepaid Debit Card. I accept the terms of the Everyday Spend Prepaid Debit Card Agreement. I certify that all statements made, on the entire form, are true and complete to the best of my knowledge and that I have read and agree to the Electronic Signature Terms and Everyday Spend Fee Summary.

Full Name Full Name First Last
SSN (Last 4)
CU Account Number
Mother's Maiden Name
Date of Birth Date of Birth / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email Address
Phone Type
Phone Number Phone Number - ### - ### ####
Electronic Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.