Benefit Plus Enrollment Request

BENEFITS PLUS ENROLLMENT REQUEST

Primary Member Information

Membership Number

First Name *

Last Name *

Address *

City *

ZIP Code *

Phone Number *

Email *

Joint Member Information

(If no joint member, skip to Page 3)

First Name

Last Name

Address

City

ZIP Code

Email (must be different than primary member)

Heroes Program

Are you enrolled with MCCU's Heroes Program?

Yes

No

Disclaimer

By enrolling in the Benefits Plus® Membership, I understand that $5.95* will be debited from my account on the last day of each month.

Which account would you like the membership fee deducted from?

Regular Savings

Regular Checking

Investment Checking

* Fee for members enrolled in the Heroes Program differs. Please visit our website for details.

Thank you for submitting your request. A member from our team will be contacting you shortly to verify your information. Please be aware that your request may require a signature which can be completed via our Secured eSignature platform.