Full Government Name
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Tribal Name
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Personal SSN#
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Email
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Phone
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Address
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City
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State
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Postal code
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By signing and submitting this form, you are giving the Foreign National Charitable Holdings TR permission to obtain, fund, and issue a custom-designed prepaid debit card in your private tribal name. By signing and submitting, you are also acknowledging that you understand that you are fully responsible for creating, monitoring, and managing your own prepaid debit account. You also acknowledge and understand that, due to FDIC banking rules, laws, and regulations, your prepaid debit card account must be established in your U.S. government name and SSN. By submitting this form, you are also giving us permission to activate your debit card on your behalf.
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