I agree to the Disclosure of Terms and Conditions of Electronic Banking.

I authorize Alco Federal Credit Union to activate the following account(s) on the Electronic Banking System.
I understand that the account(s) listed below will be accessible to me through Electronic Banking.

Print this form and after you have completed it, mail it to or bring it by

Alco Federal Credit Union
2859 Lindy Lane
Wellsville, New York 14895

or

Alco Federal Credit Union
44 West Main Street
Cuba, New York 14727

Account Information:
Share Account# 1: _____________________ Share Account# 4: _____________________
Share Account# 2: _____________________ Share Account# 5: _____________________
Share Account# 3: _____________________ Share Account# 6: _____________________

Alco FCU may notify me by e-mail that my account(s) has been activated.
Contact Information:

Your Name: __________________________________________________
Your E-Mail Address: __________________________________________________
Date: __________________________________________________
Signature: __________________________________________________