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Join our Family at PCU

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
SSN / TIN*
Driver's License Number*
Date of Birth*
Home Phone*
Work Phone
Employer
Membership Eligibility
Learn more about eligibility requirements.
Family Member Name
If you selected "Family Member", please list the name of the person who meets the criteria, their relationship to you, and their eligibility. For instance, if your parent is on staff at a local church, you would enter something like "J Smith - parent - local church staff."
Email*
Enter Email Confirm Email
For which services are you inquiring? (Check all that apply.)*
- Select All
- Share/Savings
- Share/Draft Checking
- Share Certificate/Certificate
- Other
If other, please specify.

Type of Account*
- Individual
- Join Account with Rights of Survivorship
- Joint Account without Rights of Survivorship
Designate the ownership of the accounts and responsibility for the services requested.
Number of Joint Owners
Joint Owner #1
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Joint Owner #2
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. If an access card or EFFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
Primary Member/Owner Signature*
Under penalties of perjury, I certify that: 1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued), and 2)
Joint Owner #1 Signature
Joint Owner #2 Signature