Abstract: A novel, multi-purpose printed form is provided. It consists of a longer er section, which is a single sheet of paper with varied printing on both sides, and a lower section, that is a three-sheet combination which is initially secured to one another along the lower margin thereof. The sheets are readily separable by manual handling after entry of a four digit or so number, that is personally selected by the card applicant. This number will later be needed for all uses of the card in an automatic teller computer machine (ATM). The form serves to provide a tamper-proof method to generate the personal money debit card.