Chestnut Run FCU
P O Box 5037, Wilmington, De 19808-0037
If you have any questions regarding the Statement Copy Request please contact the Tellers at (302) 999-2967. They may also be contacted via e-mail at tellers@chestnutrunfcu.org.
This Statement Copy Request may be submitted electronically by clicking on the Submit Button or printed, signed and faxed to the Credit Union at (302) 999-4889.

Member (Account) Number:

Last Name:

First Name:

Street Address:

City:

State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip:

Work Phone Number:

Home Phone Number:

E-Mail Address:

Request A Statement Copy For The Above Member Number
By Entering A Date Range In The Fields Below:

  Start Date:    MM/YY

End Date:    MM/YY

Do You Want Copy: -----------------------Select One----------------------- Mail Copy Will Pick Up Copy At The Chestnut Run Office Will Pick Up Copy At The Glasgow Office Fax Copy (Fill In Fax Number) Fax Number:

There Is A Fee Of $2.00 Per Statement Copy.
Please Select Method Of Fee Payment:

------------------------------------Select One------------------------------------- Transfer Fee From My Checking Account Transfer Fee From My Savings Account I Will Pay The Fee In Cash When I Pick Up The Statement Copy

Comments:

Signature: Date:

Office Use Only:
$2.00 Statement Copy Fee Charged To Member’s Account Via ALS Screen:
Amount Charged:_____________     Teller:________     Date Charged:________________