Home > Tools & Resources > Forms > Visa Credit Card Replacement Order Form + A A A - visa credit card replacement form things to know... Consumer Credit Card Agreement Electronic Forms Submission Agreement Please note there is a $10 replacement card fee Cards will be mailed to address on account * Required Fields Use this form to order a replacement Visa card if yours is broken or no longer working.ALERT: If your credit card is lost or stolen, do not complete this form. Please contact us right away to cancel your existing card and order your replacement card. Cardholder Name: Member Number: Last 4 digits of SSN: Phone: Reason for New Card: Additional Information: There is a $10 replacement card fee. Please indicate which account you would like your replacement card fee to be drawn. (i.e 000 regular savings, 030 checking, 040 money market) Account suffix: **Cards will be mailed to address on account**By clicking “Submit” I am agreeing to the terms and conditions, listed under "Things to Know". Security Code: Security Code