• OK Name is required
  • OK Address is required
  • OK Last 4 Digits of Primary Account is required
  • OK Last 4 Digits of Social Security Number is required
  • OK Amount of Most Recent Deposit is required
  • OK Last 4 Digits of Card Number is required
  • OK Phone is required
  • OK E-mail is required
    OK If you provide your contact information you authorize Fidelity Bank or its affiliates to contact you. Your authorization allows us to use text messaging and automatic telephone dialing systems in connection with calls made to any telephone number you provide, even if the telephone number is assigned to a cellular or mobile telephone service or other service for which the called party is charged. You may contact us anytime to change these preferences. is required
    OK By selecting this box I acknowledge that I am not under the age of 13 and approve submission of this information. is required
  • OK is required