ATM CARD APPLICATION
Click here to view ATM AGREEMENT
NAME 1 PRIMARY MEMBER       DATE
   
NAME 2 JOINT MEMBER         
       
ADDRESS   CITY STATE ZIP
 
ACCOUNTS DESIRED TO BE ACCESSED
Share Draft Account #      Share Account #     
       

   _______________________________
   Signature 1
 
FOR OFFICE USE ONLY
AUTHORIZED BY
DATE
CARD NUMBER
WD LMT.
   _______________________________
   Signature 2
 
Note:
Your "PIN" must be selected when application is submitted.
Two signatures are required to receive two cards.


Signature(s) os applicant(s) acknowledge receipt of disclosures as required by the Electronic Funds Transfer Act (Regulation E).

BRING APPLICATION TO:

Artesian City federal Credit Union
100 Flint Avenue
Albany, Georgia 31701

  You Must Print, Sign, and Return to Credit Union