Check Card Request

Baylake Bank.  Helping Build the Good Life. Member FDIC Name
Social Security #
Home Phone #
Work Phone #
Date of Birth
Home Address
Second Name on Account
Social Security #
Date of Birth
Second Work Phone #
(Required) Checking Account Number
Savings Account Number
I would like one card issued in my name only.
I would like two cards issued, one in my name and one in the second name listed above.
I am interested in a business check card. 

Print the completed form now.  Sign and date this request and mail it to:
Baylake Bank
Attn: Data Processing
217 N. 4th Avenue
Sturgeon Bay, WI  54235-2405

Signature                                                              Date
Second Card Holder Signature                                Date

Member FDIC