debit card replacement request

Personal Information

First Name*

Last Name*

Current Address*

City*

State*

Zip Code*

Email Address*

Home Phone Number

Work Phone Number

Cell Phone Number

Last 4 Digits of Social Security Number*

Keyword*

Note: Keyword is NOT your online user password. This is something you created when you set up your account. Please be aware that we have the option to contact you before we complete this request.

Card Information

Card Number to Replace*

Replacement Reason

Damaged Card
Lost
Stolen
Name Change
Closed

Account number(s) to be accessed by replacement card*:

Checking Account Number(s)

Savings Account Number(s)

By submitting this request, I agree that my use of the VISA® Check Card will be governed by the terms and conditions controlling the use of the VISA® Check Card. It is further agreed that my use of the VISA® Check Card will be governed by the rules and regulations of Liberty Savings Bank, F.S.B., as amended from time to time, that are applicable to the account(s) indicated above. We monitor for suspicious activity on all debit cards. When your risk threshold is met, we may text or call you to alert you to verify the activity on your debit card.

For after-hours response please call 800-472-3272.

debit card replacement request

Personal Information

Card Information

Account number(s) to be accessed by replacement card*:

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