Card Request | Frenchman Valley Coop

Cardtrol Card Request

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Customer Name

Second Line Name (if desired)

Number of Cards Requested

Personal Identification Number (PIN) required?

Yes
No**

A specific four-digit PIN will be automatically generated for you.

If more than one card requested, same PIN?

Vehicle ID number required?

Odometer reading required?

Customer Signature

Clear Signature

**I understand that by having no Personal Identification Number (PIN) assigned to my card, Frenchman Valley Farmers Cooperative, Inc. will be held harmless for any unauthorized use of card until such time that Frenchman Valley Farmers Cooperative, Inc. is notified that the card has been lost, stolen or misplaced. Frenchman Valley Farmers Cooperative, Inc. agrees to lock out lost or stolen cards to prevent further use

Date

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