"Checks for Less" Order Form

Please fill out all fields and use the Submit button at the bottom of the form to transmit your application. This form is secured using Verisign digital certificate encryption for your protection.

Use this form to order checks from "Checks 4 Less" only. If you need to reorder Deluxe checks, please use this form. Either form can only be used by current Farmers & Merchants Bank checking account holders. Thank you.

Please fill out the information below and we will gladly process your order. As with all check orders, your checking account will be automatically debited.

Checks should arrive in the mail in 7-10 business days. If you do not receive your checks within that time or if you have any questions, please contact Farmers & Merchants Union Bank.

Personal Information
Name:
Joint Owner Name:
Address:
City:
State:
Zip:
E-mail:
Home Phone Number :
Checking Account Number:
Which style would you like:
How many boxes would you like?
I would like: Single checks or Duplicate checks
Would you like your phone number to appear on your checks?	Yes No
If you would like your driver's license number on your checks, please provide that for us here:
What number would you like your checks to start (or continue at:(0-9000):	*Optional
Questions or comments?

Farmers & Merchants Union Bank is participating in the FDIC's Transaction Account Guarantee Program. Under the program, through December 31, 2010, all noninterest-bearing transaction accounts are fully guaranteed by the FDIC for the entire amount in the account. NOW accounts paying a higher rate of interest will not be eligible for the additional coverage under the program. Coverage under the Transaction Account Guarantee Program is in addition to and separate from the coverage available under the FDIC's general deposit insurance rules. On May 20, 2009, FDIC deposit insurance temporarily increased from $100,000 to $250,000 per depositor through December 31, 2013.

"Checks for Less" Order Form

Personal Information