Debit Card Application

Applicant Information
Card Information
**a signature may be required for New Debit Card applicants
There is a $10.00 fee for any lost or damaged debit cards. If you suspect fraudulent use of your debit card, please call Glasford Bank at 309-389-2551 or the number on the back of your card immediately.
Submitting this form will constitute an agreement that the use of the card will be governed by our Electronic Funds Transfer Service Agreement.
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