Please note ... all items displayed in bold red type are required

     Name of reporting CU employee: First Last

      Credit Union: Select Barre Catholic Bennington County Bennington E/E Federal Border Lodge Bryant Federal Caswell Central VT Med Center, Inc. Central VT Teachers Champlain Valley Covered Bridge CVPS Employees' Federal Family Granite Hills Green Mountain Heritage Family Federal Members 1st New England Federal NorthCountry Federal Northeast Schools and Hospital Opportunities Orlex US Government ECU P.M.H. River Valley Rutland Cty Teachers/Mun. ECU St. Patricks Parish United Community VT Federal VT State Employees VT VAF Employees Federal White River Windham County VEA Windsor County South Windsor-Orange County   Your Email:

     Please describe in as great a detail as possible the conditions of the fraud or scam:

     May we contact you via email for more information if necessary? Yes  No