Custom Card Order

Cardholder & Account Info

Name of Cardholder
OK Name of Cardholder is required
E-mail
OK E-mail is required
Phone
OK Phone is required
Address
OK Address is required
Member Account Number
OK Member Account Number is required
Last 7 Digits of existing Revity Credit Union check card
OK Last 7 Digits of existing Revity Credit Union check card is required
PIN Number
OK PIN Number is required

Is this card a
- Replacement card
- New account or first request for Revity Credit Union check card
OK Is this card a is required

Please choose one
- Personal Photo
- Revity Credit Union Custom Design
OK Please choose one is required
Description of personal photo (i.e. dog, kids, family)
OK Description of personal photo (i.e. dog, kids, family) is required
- I understand that a $5 personalization fee may apply.
OK I understand that a $5 personalization fee may apply. is required
Select Revity Credit Union Custom Design
OK Select Revity Credit Union Custom Design is required
- I accept the $5 replacement card fee OR
- This is a first-issue Revity Credit Union check card (no fee incurred)
OK is required

Please choose an option:
- Mail to address provided above (allow 3-4 business days for delivery)
- Pick up at a Revity Credit Union branch (available in 2 business days)
OK Please choose an option: is required
Choose Branch
OK Choose Branch is required