Debit Card Profile
Date:
Credit Union:
Contact Name:
Address:
Asset Size:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AB
BC
MB
NB
NL
NS
ON
QC
SK
AE
PR
Zip:
Authorization Method:
On-line
Off-line
Phone:
Software Provider:
Fax:
Email:
EXISTING CARD PROGRAMS
Do you have an existing
Credit
card program ?
Yes
(
MasterCard
OR
Visa
)
No
Card Supplier:
BIN Number 1:
BIN Length:
PAN Length:
Number of cards issued:
Processor:
Processor Expiration Date:
BIN Number 2:
BIN Length:
PAN Length:
Number of cards issued:
Do you have an existing
Debit
card program ?
Yes
(
MasterCard
OR
Visa
)
No
Card Supplier:
BIN Number 1:
BIN Length:
PAN Length:
Number of cards issued:
*Number of transactions per month:
*Total monthly purchases:
$
*Volumes Are Defined As Retail Sales And Cash Advances
Processor:
Processor Expiration Date:
BIN Number 2:
BIN Length:
PAN Length:
Number of cards issued:
*Number of transactions per month:
*Total monthly purchases:
$
REQUESTING PRICING FOR
Debit Product Requested:
Debit MasterCard
OR
Visa Debit
Number of BINs requested:
Fraud Program(s):
Advanced Authorization
Falcon
Card Activation:
Yes
No
CO-OP Financial Services Plastics Program
*Estimated number of transactions per month:
*Volumes Are Defined As Retail Sales And Cash Advances
Card Supplier:
Risk Finder
Other
Card Activation Method:
CO-OP Financial Services to Provide Chargeback Services
Estimated number of cards to be issued:
*Estimated total monthly purchases:
$
MEMBERSHIP (Please indicate your current or desired membership status)
Mastercard Debit
Principal Member
Affiliate Member
Principal Debit Licensee
Affiliate Debit Licensee
The participation as an Affiliate Debit Licensee is authorized for CU’s sponsored by a Principal Debit Licensee (CO-OP Financial Services) to issue cards without becoming a MasterCard member. Principal Debit Licensees may issue cards and sponsor Affiliate Debit Licensees.
VISA Debit
VISA Business ID
Participant Member
Associate Member
Principal Member
Has your Credit Union had a relationship with VISA since February 10, 1992 on EITHER the credit or debit side?
Yes
No
