| United Financial CU eStatements Opt Out Response Please print this form, fill it out and fax to Close this Page |
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Mailing Address: United Financial Credit Union I am exercising my opt-out option as permitted by law. |
| Last Name: | Middle Name: |
| First Name: | Account Number: |
| (Note: Anyone listed on the account may elect to opt out on behalf of all account holders) | |
| Please list any additional account numbers for which the opt out will apply | |
| Additional Account 1: | |
| Additional Account 2: | |
| Additional Account 3: | |
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| Signature: | Date: |