Yes!
Open a Lighthouse Community Credit Union checking account for me!
I have lived in ________________________________________ for the past ___________________ years.
(State)
(# of years)
Please send me the brochure: "How to Successfully Manage Your Checking Account"
Complete the check order request form, sign and fax completed application to the credit union at 360.694.0693 or
mail to Lighthouse Community Credit Union 702 Jefferson St., Vancouver, WA 98660. You can reach us by
calling 1.800.694.8329, or email at [email protected], or on the web at www.lhccu.com.
Signature _________________________________________________________________
Date ____________________________
Joint Signature ____________________________________________________________
Date ____________________________
Harland Clarke
Please type or print information as it appears on checks
Style
Code
 1 Box
 2 Boxes
 3 Boxes
_____ Boxes
Starting
Check No.
Line 1
Typestyle (if different from default)
Line 2
Billing (Circle One):
Optional Accessories:
Line 3
Account Holder
Financial Institution
FI Employee
Other:
Covers
Wallets
Stamps
Line 4
Line 5
______________________
Monogram or Accent:
Line 6
Center Accent:
Date
/
_________________
Enter Product Code
Sig Cut:
Check if 2nd Line for 2nd Signature needed
Sig Line Message(two 40-character lines max):
Shipping Address
(If different from
check)
323383352a
____________________________________________________________________________
FI Contact Name:
79880
Phone:
Lighthouse Community Credit Union
702 Jefferson Street
Vancouver, WA 98660
Acct #: ___ ___ ___ ___ ___ ___ ___
I would like to add (choose one):
o
o
ATM card -ORVISA Debit Card
Print Applicant Name:
Social Security No:
Print Co-Applicant Name:
Social Security No:
Address:
City:
Years at Present Address
Work Phone
State:
Account No:
Zip Code
Home Phone:
Applicant Signature:
Date:
Co-Applicant Signature:
Date:
/