PFCU Online Membership Application

The USA Patriot Act requires identity verification for all new accounts.

Important information about procedures for opening a new account:
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.

What this means for you:
When you open an account, we will ask you 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.

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Membership Application

PFCU

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

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The items marked with (*) are required fields.

General Information
Will there be a co-applicant on this application? No Yes, 1 co-applicant Yes, 2 co-applicants (If Yes, the co-applicant section has the same required fields as the primary applicant.)
Membership Eligibility *I am eligible for membership through:
Education	(Attends School In)
Employer	(Employer Name)
Family Member	(Family Members Name)
Worship	(Church Name)
Other

Your Account Options
Choose between our all inclusive account options that will set you up with the best and most popular product/service combinations that we offer, or customize your account to have the perfect products and services to match your needs.

All inclusive Account includes:

Regular Savings
Debit Card
Direct Deposit - have your paycheck, social security or any other monthly deposit automatically deposited to your account for your convenience.
Finance Central - online banking
E-Statements - receive your monthly statement online as part of our Finance Central.
Bill Central - our online bill payment services

Customize Your Account

1. Savings
Regular Savings
Money Market
CD
Club Savings

2. Checking
Checking

3. Loans
Auto/RV
Home Equity/Home Improvement
Mortgage
Signature Loan
Credit Card
Other

4. Electronic Services
ATM/Debit
Direct Deposit
Bill Central - our online bill payment services
Finance Central - online banking
E-Statements

5. Business Services

Primary Applicant
*Last Name
*First Name
Middle Name
*Social Security Number (TIN)	--
I certify that: The TIN is correct and I AM / AM NOT subject to back-up withholding and I am a U.S. Person (including a U.S. Resident Alien).
*Date of Birth	//
*Home Phone Number	--
Work Phone Number	-- ext.
Number	-- ext.
*Email Address
*Drivers License #
*Drivers License State
*Drivers License Expiration Date	//

*Mother's Maiden Name

Secure Word	This Secure Word may be asked for verification via phone transactions/inquires to help identify you.

Home Address (not P.O. Box)
*Address 1
Address 2
*City
*State
*Zip	-

Mailing Address	Same as Home Address
*Address 1
Address 2
*City
*State
*Zip	-

Employment History
Currently Employed?	Yes No
Present Employer Name
Employer Phone Number	-- ext.
Job Title
Years on the job
Employer's Address
Address 1
Address 2
City
State
Zip	-

Co-Applicant 1 (if applicable)
*Last Name
*First Name
Middle Name
Relationship to Primary Owner
*Social Security Number (TIN)	--
*Date of Birth	//
*Home Phone Number	--
Work Phone Number	-- ext.
Number	-- ext.
Email Address

*Drivers License #
*Drivers License State
*Drivers License Expiration Date	//

Secure Word	This Secure Word may be asked for verification via phone transactions/inquires to help identify you.

Co-App Home Address (not P.O. Box) if different than primary applicant's address
*Address 1
Address 2
*City
*State
*Zip	-

Co-App Mailing Address if different than primary applicant's address	Same as Home Address
*Address 1
Address 2
*City
*State
*Zip	-

Co-App Employment
Present Employer Name
Employer Phone Number	-- ext.
Job Title
Years on the Job

Co-Applicant 2 (if applicable)
*Last Name
*First Name
Middle Name
Relationship to Primary App
*Social Security Number (TIN)	--
*Date of Birth	//
*Home Phone Number	--
Work Phone Number	-- ext.
Number	-- ext.
Email Address

*Drivers License #
*Drivers License State
*Drivers License Expiration Date	//

Secure Word	This Secure Word may be asked for verification via phone transactions/inquires to help identify you.

Co- App 2 Residence Address (not P.O. Box) if different than primary applicant's address
*Address 1
Address 2
*City
*State
*Zip	-

Co- App 2 Mailing Address if different than primary applicant's address	Same as Home Address
*Address 1
Address 2
*City
*State
*Zip	-

Co-App 2 Employment
Present Employer Name
Employer Phone Number	-- ext.
Job Title
Years on the Job

References
Nearest relative Not Living With You
*Last Name
*First Name
Relationship
* Number	-- ext.
Address 1
Address 2
City
State
Zip	-

Additional Information
*How would you prefer to be contacted? Home Phone Work Phone Cell Phone Email Address Other
Special Instructions/Comments
Back to top of page \| Jump to Submit Button By submitting this form, I authorize PFCU to obtain a credit report and verify my employment information. I understand that I must maintain a $5.00 Share Savings Account balance for membership. Upon receipt of this form, PFCU will review my membership application and upon approval, will contact me for instructions on completion of membership.