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*:
SSN/TIN*: Don't Have
Date of Birth (MM/DD/YYYY)*:
/ /
If no SSN/TIN please leave blank.
Driver's License Number*:
Issuing State*:
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.
User Name*:
Verify Password*:
This is your Username and Password for our Online Home Banking System.
Passwords: are case sensitive; must not be the same as your username; must be between 8 and 20 characters long; must contain at least 1 number; may contain only letters, numbers and these special characters !@#$%^&?*+=
Permanent Address
Address Type:
Address Line 1*:
Address Line 2:
No P.O. Boxes Please
Zip Code*:
Home Phone Number:
Mobile 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.
How Did You Hear About Us?
Additional Features
MemberNet - FREE
Our easy to use internet banking solution. View account histories, perform transfers, view checks posted to your account, make check copies.
BillPay - FREE (With Checking)
Pay all your bills and transfer funds online.
E-Statements - FREE
Receive all your statements electronically through MemberNet. 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.
Under penalties of perjury, I certify that:
  1. The number shown on this form is my correct taxpayer identification number,
  2. True False I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest of dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
  3. True False I am a U.S. person (including a U.S. resident alien).
Certification instructions: Check FALSE for item 2 above if you have been notified by he IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Check False for item 3 above and complete a W-8 BEN if you are not a U.S. person.

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 disclosures.
  • I authorize the credit union to retrieve my credit report.

Equal Housing Lender National Credit Union Administration Federally Insured by NCUA.
734-662-8200 or 800-968-8628 Security & Privacy Policy