Visa Payroll Card Enrollment Instructions

(* indicates a required field)

• Name:
  • First Name: *Enter your first name
  • Middle Initial: Enter your middle initial
  • Last Name: *Enter your last name
• Address
  • Street: *Enter your street address. This is where your card will be shipped.
  • City: *Enter your city
  • State: *Enter your state
  • Zip Code: *Enter your zip code
  • Phone Number: *Enter your phone number. Phone numbers must be 10 digits (Ex: 123-123-1234)
  • Email Address: Enter your email address. Not required on the form.
• Social Security Number
  • Type: *The Issuing party of the number, whether a company, government body, employer, college, school, or otherwise.
  • Number: *This number is used for activation purposes. When you receive your card, be sure to have this number available as evidence that you received your card and for card activation. Until you receive your card and activate your card with this number, your card will remain inactive. Only the last 4 digits of your social security number may be used on the form. If you do not have a social security number, or prefer to use a different number, you may select any option from the list including Passport, TIN, Green Card, Student Visa, FIN, Work Visa, Consular ID, or other ID number.
• Routine source of income
  • Name: Enter one source for routine source of income. Examples include your employer, contracting company, a spouse, a family member, a bank, an investment fund, pension, alimony, professional services, professional fees, commissions, or any other funds that you receive that will be deposited to your card.
  • City: Where the source of income is located
  • State: Where the source of income is located
  • Country: Where the source of income is locate
• Additional Information (You may be asked to verify any, or all, of this information when contacting our customer support services)
  • Language: Enter your preferred language (Spanish or English)
  • Gender: Enter your gender (Male or Female)
  • Date of Birth: Enter your birth date
  • Place of Birth: City: Enter the city where you were born
  • State: Enter the state where you were born
  • Country: Enter the country where you were born
  • Mother's Maiden Name: Enter your mother's maiden name