* Indicates required field

I authorize Waterbury CT Teachers Federal Credit Union (WCTFCU) to transfer my credit card debt to my WCTFCU VISA^® Credit Card ending in:

• Last 4 digits of WCTFCU Visa Credit Card*

WCTFCU Member Information

• Member Name *
• WCTFCU Member Number *
• Email *
• Phone *
• Comments

Credit Card #1

• Credit Card Name*
• Credit Card Payment Address*
• City*
• State*
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip*
• Account Number*
• Amount to be transferred*
• Phone*

Credit Card #2

• Credit Card Name
• Credit Card Payment Address
• City
• State
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip
• Account Number
• Amount to be transferred
• Phone

Credit Card #3

• Credit Card Name
• Credit Card Payment Address
• City
• State
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip
• Account Number
• Amount to be transferred
• Phone

In submitting this application, I certify that all credit cards listed herein are my own, and I am authorized to make these transfers. Everything I have stated in this application is correct to the best of my knowledge. I authorize WCTFCU to transfer my non-WCTFCU credit card debt listed above, to my WCTFCU VISA® Credit Card.