Order Form- Xtend Shared Branching Please fill out the form to place your order. Credit Union name* The full name of your Credit Union. CEO* The name of your Credit Union’s CEO. Contact name* The name of our contact for this project. Contact phone number* The phone number of our contact for this project. Contact email* The email address of our contact for this project. How many branches will be added to the Xtend Shared Branching network?* Individual Branch Information Please add all relevant information per branch. If more than 5 branches, please upload information here.* Name of Branch, Address, Phone, Fax (if applicable) for all locations. Accepted file types: csv, xlsx, txt, doc, docx, Max. file size: 128 MB. Name of Branch* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax Second Branch Name of Branch* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax Third Branch Name of Branch* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax Fourth Branch Name of Branch* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax Fifth Branch Name of Branch* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Fax Consent* I have reviewed this form and my answers, and give approval on behalf of my credit union for Xtend to draft a contract based on the submitted information.
