Full Name: E-Mail: Address 1: Address 2: City: State: Zip: Day Phone: Fax: Additional Info Yes, I would be interested in receiving additional information from time to time from LorMet Community Federal Credit Union Currently a member? Yes No Send more info about: Membership Free Checking Visa Card I.R.A.s Home Equity Loans Certificates Other (use space below) Comments/Questions:

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