Check Order Form Phone 760 352 1540 Fax 760 337 5422 wwwficucom Is this a new Order Yes No Reorder With Changes Without Changes All About Me My Account Number My Name Joint Ow ID: 824556
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Check Order Form PO Box 3247 El Cent
Check Order Form PO Box 3247 El Centro, CA 92244 Phone: (760) 352-1540 | Fax: (760) 337-5422 www.ficu.com Is this a new Order? Yes No Reorder: With Changes Without Changes All About Me! My Account Number: My Name: Joint Owner Name (If Applicable): About my check! (Select all information you’d like displayed on checks) My Address My Phone Number My Driver’s License Joint’s DL Mail my checks to … (shipping information) Address on Checks: Credit Union Branch: Brawley El Centro Calexico Alternate Address: P.O. Box What I would like on my checks … (Designs Style & Accessories ) Style Code:(Designs of check) Number of Boxes: One Two Three Four Starting number of check# Design on my check Monogram Accent Center Accent Sig. Cut Covers (Free Vinyl cover included) Other THIS SECTION IS FOR CREDIT UNION USE ONLY This form processed by: ___________________________________ Date: _________ Time:__________ Check Ordered by: __________________________________ Date: _________ Time: _________ Billing: (Charged to) Member Credit Union Supervisor Initial: ________________