Please note that there is a $5.00 Replacement Card fee.

Today's Date

Member Information
First Name	Last	Account Number	SSN
E-mail address:

E-mail Address

Card Information

Card Number VISA ATM

You may also print this form and fax to (402) 399-0129, mail to Omaha Federal Credit Union, 3001 So. 82nd Ave., Omaha, Nebraska 68124 or stop by one of our four office locations.

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