VISA Debit Card Enrollment Instructions

For US card holders: (International non-US card holders see below)

(* 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

For non-US (International) card holders:

Cards must be enrolled into a US address. To receive your card internationally you must use the address of your US employer, US family member, or contact located in the US who will ship your card. Once you receive your card you may update your card contact information to reflect your international address.
(* indicates a required field)

• Name:
  • First Name: *Enter your first name
  • Middle Initial: Enter your middle initial
  • Last Name: *Enter your last name
• Address (Note: once you receive and activate your card you may update the below information to your international address)
  • Street: *Enter the US street address
  • City: *Enter the US city
  • State: *Enter the US state
  • Zip Code: *Enter the US zip code
  • Phone Number: *Enter the US phone number
  • 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