Remote Deposit Capture Application

Account Number (77)

General Applicant Information

First Name Last Name Middle Initial Street Address / P.O. Box Apartment Number City State Zip Home Phone Number Work Phone Number Cell Phone Number Email Address

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Signature(s) Required: I/We acknowledge that I/we have received a copy of your First Class Remote Deposit Capture Agreement. I/We have read, understand and agree to be legally bound by the terms and conditions of such Agreement. In addition, I/we hereby authorize First Class FCU to obtain a credit report(s) to check my/our history for any or all services.

* If your account is a joint account, all owners must sign.

Applicant's Signature Applicant's Signature   Joint Account Applicant's Signature   Joint Account