Debit Card Replacement Form

This form is used to order a replacement debit card for your account. If you have never had a debit card issued to your account, please contact us at 502-584-3600 or 1-888-584-3600. You can also use our live chat services or visit your local banking center to request a new card.

Account Holder Information

Name:
Mailing Address:
City, State Zip	,

Your card and activation instructions will be sent to the mailing above and will arrive within 7-10 business days.

Debit Card Information

TrueName / Preferred Name on card*:
Cannot contain more than 21 characters Special Characters are restricted (@/\?.\|%#^&*():;)

Enter the last 4 numbers of your debit card that needs to be replaced. If you do not know the last 4 of numbers of your debit card enter in the last 4 numbers of your account number.

Reason for request:	Lost/Stolen	Note: If your card has been lost or stolen, please call 502-584-3600 or 1-888-584-3600, use live chat services or visit your local banking center to close your card. Please be aware that submitting this form does NOT ensure your card will automatically be closed.
Reason for request:	Replacement/Damaged	Note: Debit Cards that are expiring soon are automatically re-issued and there is no need to submit a request. If your card is set to expire at the end of the month and you have not received your replacement card yet please contact us at 502-584-3600 or 1-888-584-3600, use live chat services or visit your local banking center.

*This is the name that will display on your debit card. Your legal name will appear on the rest of your account documentation. Republic Bank reserves the right to not print any fictious or inappropriate names and use your legal name provided at account opening.