Join 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.

Individual Branch Information