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FDIC Trust Examination Order Form

Trust Examination Manual Order Form To order the FDIC's Trust Examination Manual, please print or type the following information. For further information on ordering procedures, call 1-877-ASK-FDIC (275-3342) or 703-562-2200. For TTD, call 800-925-4618. Institution Name: ________________________________________________________ Contact Person: ________________________________________________________ Street Address: ________________________________________________________ City, State, Zip Code: ________________________________________________________ Daytime Telephone: ________________________________________________________ Quantity Ordered: __________________________ (at $100 each) Total Amount Enclosed: __________________________ Please mail this order form and check or money order to: Wachovia QLP Lockbox-NC0810 Lockbox #70966 1525 West WT Harris Blvd. Charlotte, NC 28262 For credit card orders, please fax form to (703) 562-2296. Visa:_____    M/C:______   Card No: ________________________________ Validation Code: ________________________________   What is a Validation Code? Expiration Date: ________________________________ Name on Card: ________________________________ Signature: ________________________________

Last Updated 11/19/2007

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