ESL ATM / Visa® Debit Card Request Form

Please note: It is very important that you select the proper action so that this request can be processed as rapidly as possible. Thank you.

To report a lost or stolen card, please contact us as soon as possible at 585.336.1000, 800.848.2265, or after hours at 800.754.4128.

To select or change your PIN, please call 844.433.1140.

ESL ATM Card

ESL Visa Debit Card

User ID:
Member Number:
Member Name:
Email Address:
Address:
City, State Zip:	,

Order a New Card

Use this option when you do NOT currently have an ATM card or a Debit Card OR you wish to order another card with a different 16 digit card number. Do NOT use this option for ordering replacement cards.

Select a card type:

ESL Visa Debit Card (Also acts as your ATM card.)

ESL ATM Card

Health Savings Account Debit Card

Enter a Saving/MMA/Premier MMA/Health Savings Account Number:

Enter a Checking or Simple Spending Account Number
(Required for a Debit Card):

Enter Name 1 (Last, First, Middle Initial):

Replacement Card
Use this option when your current card is no longer working due to the plastic/card being old, the actual card is damaged, or the actual card is worn out. Do NOT use this option for replacing a Lost or Stolen Card.

Enter the Current Card Number (16 digits):

IMPORTANT INFORMATION: Your new Debit Card will be embossed with a different expiration date. Please contact any merchants who currently debit your ESL Visa Debit Card for recurring payments and advise them of the new expiration date. For security purposes, please destroy your old Debit Card once you receive your new one.

Other Action
Use this option to convert your existing card to a different card type.

Enter the Card Number (16 digits):

Select the service required:

Convert ESL Visa Debit Card to ESL ATM Card.

Convert ESL ATM Card to ESL Visa Debit Card.

Your request will be processed during the next business day.
You will receive an email confirmation AFTER your request has been processed.