Youth Membership Application

Type of Account Desired

I am interested in: *

Savings, Checking, and Debit Card (age 13+)

Savings Account Only

Youth Member Information

Name of Primary Member *

Street Address *

City, State, Zip *

Mailing Address (if different)

Date of Birth *

Social Security Number *

Phone Number *

E-Mail Address *

Employer Name

Occupation/Title

Joint Owner Information

Name of Joint Owner *

Street Address *

City, State Zip *

Mailing Address (if different) *

Date of Birth *

Social Security Number *

Phone Number *

E-Mail Address *

Employer Name (or company you retired from) *

Occupation/Title *

Joint Owner Information

Name of Joint Owner

Street Address

City, State Zip

Mailing Address (if different)

Date of Birth

Social Security Number

Phone Number

E-Mail Address

Employer Name (or company you retired from)

Occupation/Title

Membership Eligibility

How are you eligible for membership? *

Identification Information

Youth/Primary Member: Upload Passport, State ID, Driver's License, Social Security Card, or Birth Certificate *

Click or drag & drop image here to upload

Joint Owner 1: Upload Driver's License, Passport, or State ID *

Click or drag & drop image here to upload

Joint Owner 2: Upload Driver's License, Passport, or State ID

Click or drag & drop image here to upload

Opening Deposit

Web Authorization (ACH Debit) — One Time Payment

Please process the opening deposit from the following account on the next available business date:

Routing Number *

Account Number *

Name on Account *

Deposit Amount: *

$5 - Minimum to open the account

$25 - Amount to maximize the opening deposit match benefit

Account Type: *

Savings

Checking

Authorization

By checking the box below and clicking Submit, I authorize Penlanco Federal Credit Union to initiate a one time ACH/electronic debit from my bank account in the amount stated above on or after today's date, from the account I provide (routing & account number; checking or savings). I agree that ACH transactions I authorize comply with all applicable U.S. law and Nacha Operating Rules.

Error Correction

If a debit is made in error, I authorize Penlanco FCU to initiate an ACH credit to my account to correct the erroneous debit.

Revocation/Cancellation

I may revoke this authorization by contacting Penlanco FCU at 717-569-9621 or memberservices@penlancofcu.com. Penlanco FCU will either cancel the transaction, or reverse the transaction, depending on if it has already occurred.

Copy of Authorization

Penlanco FCU will provide me an electronic or paper copy of this authorization for my records and will retain it as required.

Identity Authentication & Account Validation (WEB entries)

I understand that, because this authorization is given online, Penlanco FCU may use commercially reasonable methods to authenticate my identity and validate my account before initiating the debit (e.g., secure login, micro deposit verification, or third party account validation).

Consumer Rights (E-SIGN)

By proceeding electronically, I consent to use electronic records for this authorization. I acknowledge I can withdraw consent and request paper copies at no charge by contacting Penlanco FCU at 717-569-9621 or memberservices@penlancofcu.com; and that I have the hardware/software needed to access and retain this record (e.g., a device with a web browser and PDF reader).

Authorization: *

I agree and authorize the one time ACH debit as described above.

To submit your report card for Report Card Rewards: upload the report card below or e-mail the report card to memberservices@penlancofcu.com.

Upload File

Click or drag & drop file here to upload

Thank you — your information has been received.

Thank you for your interest in joining Penlanco FCU. You can expect to receive the necessary membership forms via our secure e-sign platform within the next business day. The email notification will include a passcode for accessing the e-signing process. Once you have completed the e-signature, we will promptly finalize your account opening and process your specified opening deposit.

Should you have any questions, please contact us at 717-569-9621 (option 2) or via email at memberservices@penlancofcu.com.

We look forward to having you as part of the Penlanco FCU family!