SHAZAMChek Application Form
Please compete and return to Citizens State Bank via mail or fax to 712-335-4603.
City, State, Zip:
Social Security Number:
Date of Birth:
Savings Account #:
I agree that the bank may rely on the accuracy for the above information to obtain and/or verify my credit history, bank references, employment, and any other information permitted by law to determine my credit worthiness.
If my SHAZAMChek card is damaged, lost or stolen, I will be required to pay a replacement fee of $10.00 per card.
I understand there is a charge of $1.00 per month to have a SHAZAMChek card.