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Full Name: E-Mail: Address 1: Address 2: City: State: Zip: Day Phone: Fax: Additional Info Yes, I would be interested in receiving additional information from time to time from Dakotaland FCU Currently a member? Yes No Eligible? I work for I am related to Send more info about: Membership Checking/Overdraft Protection ATM/Checkcards 24-Hour Access/E*Teller/Phone Certificates & IRAs Visa Credit Cards Consumer Loans Real Estate Loans Business Loans Other (please specify below) Comments/Questions:

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