Today's Date

Member Information
First Name	Last	Account Number	E-mail Address

Day Time Phone Number(s)	Fax Number

[] Please Send Mortgage Application To:
Mailing Address	City	St	Zip

[] Request Your Payoff
Property Address	City	St	Zip

Loan Number	Loan Type:
	First Mortgage	Second Mortgage	Home Equity

How would you like to receive your information?
Mail Fax Pick Up - Select Branch - - Main Office - Downtown Office - Blair Office - VA Office

[] Loan File Information Request
Property Address	City	St	Zip

Loan Number

Copy of Your: Fee: [] Appraisal N/C [] Note N/C [] Deed of Trust N/C [] Amortization Schedule N/C [] Account/Statement History $2.00

[] I agree my account will be debited for this service. Account Number

How would you like to receive your copy(ies)?
Mail Fax Pick Up - Select Branch - - Main Office - Downtown Office - Blair Office - VA Office

[] Send New Payment Statement
Payment Statement will be mailed to the member account address.
Property Address	City	St	Zip

Loan Number

You may also print this form and fax to (402) 399-1029, mail to Omaha Federal Credit Union, 3001 So. 82nd Ave., Omaha, Nebraska 68124 or stop by one of our four office locations.