Balance Transfer Request Personal Information Last Name First Name MI Social Security Number Mother's Maiden Name Member Number Last four numbers on your CUA Visa Card Address City State Zip Code Home Phone Work Phone () -Second partThird part () -Second partThird part CUA is hereby authorized to pay off the balance(s) due on the following charge account(s) by issuing the check(s) as indicated and adding the balance to my Credit Union of America VISA Card account (may not exceed CUA VISA Card credit limit). Checks will be issued directly to the creditor(s). The credit union is not responsible for payments which are late or lost in the mail. Rates and Terms for Balance Transfers are located here. Credit Card 1 Name on Credit Card Creditor/Payee Name Account Number Amount to Pay $ Payment Address City State Zip Code Credit Card 2 Name on Credit Card Creditor/Payee Name Account Number Amount to Pay $ Payment Address City State Zip Code Credit Card 3 Name on Credit Card Creditor/Payee Name Account Number Amount to Pay $ Payment Address City State Zip Code Credit Card 4 Name on Credit Card Creditor/Payee Name Account Number Amount to Pay $ Payment Address City State Zip Code Security Code Before submitting, please type in the security code below: