Georgia Florida United Methodist Federal Credit Union

APPLICATION FOR ATM/DEBIT CARD

I'd like to apply for the following card(s):

Debit/Check Card

DEPOSITOR

Street Address	City	State	Zip Code
______________________________________________________________________________________________

Previous Address (if less than three years at present address)

______________________________________________________________________________________________

Date of Birth	Social Security No.	Mother's Maiden Name
______________________________________________________________________________________________

DEPOSITOR 'S EMPLOYER

Employer	How Long?
______________________________________________________________________________________________

Address

______________________________________________________________________________________________

Street Address	City	State	Zip Code
______________________________________________________________________________________________

Position-Job Title	Annual Income	Telephone Number
______________________________________________________________________________________________

* NOTICE: You need not list income from alimony, child support or separate maintenance if you do not want it considered.

JOINT DEPOSITOR

Street Address (IF DIFFERENT FROM DEPOSITORS)	City	State	Zip Code
______________________________________________________________________________________________

Date of Birth	Social Security No.	Mother's Maiden Name
______________________________________________________________________________________________

JOINT DEPOSITOR 'S EMPLOYER

Employer	How Long?
______________________________________________________________________________________________

Address

______________________________________________________________________________________________

Street Address	City	State	Zip Code
______________________________________________________________________________________________

Position-Job Title	Annual Income	Telephone Number
______________________________________________________________________________________________

SIGNATURE(S)

By signing below, the undersigned request(s) the described services and agrees to the terms and conditions governing the services, including any fees and charges. The undersigned agree(s) that all information is accurate and authorizes the financial institution to verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency.
X___________________________________________	X_____________________________________________
Signature of Depositor. Date	Signatureof Joint Depostior Date

Print, fill out , and mail this membership request to:

Georgia Florida United Methodist Federal Credit Union
P.O. Box 6448
Marietta, GA 30065-0448