826 North 3rd Street, Waco, TX 76707 Phone: (254) 753-0361 •  Fax: (254) 753-0371

You MUST currently be a WACO FCU member to complete this form! The information requested below is for the primary member on the account.

Member Account Number First Name Middle Name/Initial Last Name Street Address City State Zip Code Select.......... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Home Phone # Cell Phone # Work Phone # Ext: Email Address Last 4 Digits Of Social Security # Birthdate (MM/DD/YYYY)

By submitting this request, I acknowledge that I have read and agree to the terms of the Home Banking Disclosure