SHAZAMChek Application Form
Please compete and return to CSBank via mail or fax to 712-335-4603.
Name:
 
Address:
 
City, State, Zip:
Home Phone:
Work Phone:
Social Security Number:
Cell Phone:
Date of Birth:
 
Checking Account#:
 
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. 
Signature:__________________________
 
Date:__________________________
 

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