Balance Transfer Form

Fields marked with * are required.

Member Information

• Member Name *
• Member Number *
• VISA Account Number *
• Expiration Date *

Account #1

• Card Issuer *
• Exact Amount *
• Card Issuer 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 *

Account #2

• Card Issuer
• Exact Amount
• Card Issuer 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

Account #3

• Card Issuer
• Exact Amount
• Card Issuer 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

By submitting this form, I authorize Earthmover Credit Union to bill my approved Visa credit card account in the amount(s) listed. In addition, Earthmover Credit Union will not be responsible for any charges billed to me for these account(s).

Please allow up to 2 weeks for processing. No balance transfer fee.