I designate the following as Authorized User(s) on my Signature Federal Credit Union Visa Debit card. I hereby certify that I will be solely responsible for all transactions by the Authorized User(s). The debit card and the monthly checking statements will be sent to my address that I have on file with my checking account.

Authorized Users are as Follows

Name	DOB	SSN
User Name 1	Date and time	User SSN 1
User Name 2	Date and time	User SSN 2
User Name 3	Date and time	User SSN 3
User Name 4	Date and time	User SSN 4
User Name 5	Date and time	User SSN 5
User Name 6	Date and time	User SSN 6

Signatory Authorization and Agreement

Signature		Date
		Date and time
Member Number	VISA Card Number	Daytime Phone
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