I cannot add a card to complete my Apple ID

Hello, I am trying to add my Visa debit card to my Apple ID account. In “complete your Apple ID>Payment Method”, I entered all of my card information several times, double checked to see that I filled out all of the information, and clicked next. As soon as I clicked next, I got a red message at the top of the screen that said “You did not complete the entire form.” I went back and did it again multiple times with no success. I tried scanning my card and entering the information in manually, but I continued to get the same message. I need to add my debit card but my phone will not let me. Here is a photo of the message: