Primary Account Holder Information
Type of Membership:
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.
First Name*:
Middle Name/Initial:
Last Name*:
What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.
Mother's Maiden Name*:

Not Yet Issued/No SSN Assigned
Date of Birth (MM/DD/YYYY)*:

/ /
ID Type:
Driver's License Number*:
Issuing State*:
Passport Country:
You may enter your State ID or Passport Number. If passport Number Select Passport as Issuing State.
ID Expiration Date (MM/DD/YYYY)*:
/ /
Membership Affiliation*:
Please choose which Affiliation applies to your Membership.
Permanent Address
Address Type:
Address Line 1*:
Address Line 2:
No P.O. Boxes Please
Zip Code*:
Mobile Phone Number:
Home Phone Number:
Home Phone or Mobile Phone must be given.
E-mail Address*:
Verify E-mail Address*:
If your mailing address is different please check here.
Options and Benefits
Share Savings - Required for Membership
This basic Share is required with a minimum balance of $5.00
Deliver Card To:
Visa Credit Card(requires additional information.)
No annual fees, fixed interest rate, at least 25 day grace period, ATM access, overdraft option.
Click here to review our Visa Platinum and Cash Rewards Application and Solicitation Disclosure
Auto Loan(requires additional information.)
Home Equity Loan(requires additional information.)
Mortgage Loan(We will contact you to follow up with additional information)
Other Loan(requires additional information.)
How Did You Hear About Us?
Additional Features
Online Banking - FREE
Our easy to use internet banking solution. View account histories, perform transfers, view checks posted to your account, make check copies.
Bill Pay - FREE (With Checking)
Pay all your bills and transfer funds online.
E-Statements - FREE
Receive all your statements electronically through Online Banking. Paper statements available at $1 per statement.
Mobile Banking - FREE
Our easy to use Mobile Banking solution. View account histories, perform transfers, and pay your bills all from the convenience of your smartphone.
TIN Certification & Backup Withholding Information

Under penalties of perjury, I certify that:

  1. The number shown on this form is my correct taxpayer identification number.
  2. I am not subject to backup withholding because I am exempt from backup withholding due to failure to report all interest and dividends.
  3. I am a U.S. person (including a U.S. resident alien) and am exempt from FATCA reporting (U.S. citizens and resident aliens should select "True". Only select "False" if you are a non-resident alien who is exempt from U.S. tax reporting).
    If you checked False for item 3 above your signature does not serve to certify this section and you must complete a W-8BEN certifying your foreign status for U.S. tax reporting.

By clicking "Accept", I agree to the following:

  • I confirm that I have opened and reviewed the Electronic Statement Disclosure and that I consent to receiving statements, notices and other disclosures electronically.
  • I agree to the terms and conditions in the credit union's new member account disclosures and abide by and comply with all local, state, and federal rules and regulations.
  • I acknowledge that the Credit Union may obtain my consumer credit report from its designated credit reporting agency(ies) to review or collect my existing credit account(s) with the Credit Union. I further acknowledge that the information derived from my personal credit report or other information from credit reporting agencies, in addition to being used to review my existing credit accounts, may also be used to determine my eligibility for loan products and other services with the Credit Union and for communicating such eligibility to me. I understand that upon request, the Credit Union will provide me with the name(s) and address(es) of the consumer reporting agency(ies) that furnished any reports used in determining my eligibility for any or all products or services.
  • By signing the Membership application/signature card, you agree to be bound by the terms of the card as well as this Disclosure & Agreement as amended from time to time. You authorize us to obtain information from credit reporting agencies and financial institutions about your other checking and savings accounts and credit history. We may provide information about your account and your credit history with us to other persons, including credit reporting agencies.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.