PIN
Selection Form


___________________________________
Date

___________________________________
Account Number

I, __________________________________,
Please Print Your Name

select the 4-digit number below as my Personal Identification Number (PIN) for my:
___ VISA Credit Card
___ VISA Check Card
___ MONEY NOW Card
___ MATT

I understand that I should keep a record of this new number as it will NOT be kept on file at Mid American.


___________________________________
Signature

New PIN: _____    _____    _____    _____

 

Mail completed form to:
Mid American Credit Union
8404 West Kellogg Drive
Wichita, Kansas 67209
Or, you may fax it to: (316) 722-0920