United 1st Federal Credit Union


	VISA Check Card Application and Member Information

Main Office
St. Marys Member Service Center
2000 Osborne Road
St. Marys, GA 31558

Account #
Member Name

Street Address
City
State Zip

Home Work

Joint Owner Information (if applicable)

Member Name

Street Address
City
State Zip

Home Work

By signing below, you certify that the information on this application is complete, true, and submitted for the purpose of obtaining a VISA Check Card. If approved for a VISA Check Card, you acknowledge receipt of and agree to the terms of the VISA Check Card Agreement.

_______________________________
Signature

________________
Date

_______________________________
Signature

________________
Date

For Credit Use Only:

Approved By		Member Verification
Access Card		PIN Requested

You Must Print, Sign, and Return to Credit Union
by mail (P.O. Box 6150 St. Marys, GA 31558), fax (912-882-8559), or in person
A signature is needed to complete the process.
If this page is printed and faxed to the credit union, please include a copy of a photo ID along with your request.

Before printing make sure your print margins are set to 0.2"
Look under File menu, Click on Page Setup, then change margins to 0.2"

If this page is printed and faxed to the credit union, please
include a copy of a photo I.D. along with your request.