ATM or Visa Check Card Application

Please print out and deliver to any River City FCU office.

Checking/Savings Account Number                                                                                                                                                                   

Primary Member Name                                                                                                                                                                                           

DL/ID#                                                                                              SS#                                                                                                                

Mother’s Maiden Name                                                                            DOB                                                                                                   

Telephone (      )                                                                                  Work Phone (      )                                                                                    

Address                                                                                                                                                                                                                   

City/State/Zip                                                                                                                                                                                                         

Joint Owner Name                                                                                                                                                                                                  

DL/ID#                                                                                              SS#                                                                                                                

Mother’s Maiden Name                                                                          DOB                                                                                                     

Telephone (      )                                                                                 Work Phone (      )                                                                                    

Address                                                                                                                                                                                                                   

City/State/Zip                                                                                                                                                                                                         

I hereby request that River City Federal Credit Union (RCFCU) issue me an ATM or Visa Check Card.  Use of my card indicates that I have read and agree to abide by the terms of the Electronic Funds Transfer (EFT) Agreement and Disclosure provided to me.

I further agree that my use of the ATM or Visa Check Card is governed by the Bylaws of the credit union, rules and polices now in effect, which may be amended from time to time.  I understand that a consumer credit report may be requested in connection with this application and with any renewals or updates.

I acknowledge that everything stated in this application is true and correct.

Primary Member Signature                                                                                                                       Date                                                   

Joint Owner Signature                                                                                                                              Date