Membership Application

Please provide as much information as you can. Missing information may cause delays in completing your request. Once you have completed and submitted this online form, one of our Representatives will contact you to complete your request.

Membership Information

If Employer, enter your employer name here

If Family, enter family members first and last name here

Primary Owner Information

Enter Social Security Number *

First Name *

Middle Name

Last Name *

Enter Date of Birth *

Driver's License or Government ID Number *

Upload Image of Front of Photo ID *

Click or drag & drop image here to upload

Upload Image of Back of Photo ID

Click or drag & drop image here to upload

Employer *

Code Word *

Mothers Maiden Name *

Backup withholding: Most people are not subject to backup withholding. If you are, you would have been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding as a result of failure to report all interest or dividends. If you have not been notified by the IRS that you are subject to backup withholding please select “I am not”.

Contact Information

Street Address (cannot be a PO Box) *

City *

Enter ZIP Code *

County *

Mailing Address (if different)

City

Enter ZIP Code

Enter Date Moved to Address *

Enter Email Address *

Enter Home Phone

Enter Mobile Phone *

Enter Work Phone

Joint Owner Information

If you would like to add a joint owner to your account please complete all of the following fields. If you do not want to add a joint owner, click Continue below.

This individual is Joint with Right of Survivorship

Enter Social Security Number

First Name

Middle Name

Last Name

Enter Mobile Phone

Enter Work Phone

Email Address

Driver's License or Government ID number

Upload Image of Front of Photo ID

Click or drag & drop image here to upload

Upload Image of Back of Photo ID

Click or drag & drop image here to upload

Employer

Address not the same as Primary Member

Backup withholding: Most people are not subject to backup withholding. If you are, you would have been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding as a result of failure to report all interest or dividends. If you have not been notified by the IRS that you are subject to backup withholding please select “I am not”.

Beneficiary/Payable on Death

If you would like to add a beneficiary to your account please complete all of the following fields. Upon the death of the last owner, ownership of the account can pass to whomever you designate as beneficiary. If you do not want to add a beneficiary, click Continue below.

First Name

Middle Name

Last Name

Social Security Number

Date of Birth

Phone Number

Street Address

City

Enter ZIP Code

I would like to add more than one beneficiary on this account

Services

I am interested in the following credit union services:

* $2.95 monthly fee for paper statement. eStatements are FREE!

eStatement/eNotice enrollment

Group Financial Education workshops

Individual Financial Counseling session

Checking Accounts

Find more information about our Checking Accounts from the link below.

Checking Accounts

In addition to my new membership I would also like to open a:

UA Checking Account

eMoney Account

Market Checking Account

To avoid any monthly fees, remember to set up direct deposit with your employer. After your new checking account has been opened we will send you all the necessary information to take to your payroll department.

Checking Account Add-Ons:

Visa Debit Card

Debit Card Round Up

Order checks (fees vary, not available with an eMoney Account)

Overdraft Protection from my vacation fund

Overdraft Protection from my new savings account

I would like to activate Courtesy Pay

Making Your First Deposit

A basic savings account will be opened to establish your membership at the credit union. This savings requires a minimum deposit of $5. There is also a $10 membership fee, for a total of $15 required. In addition, if you selected a checking account, the minimum initial deposit is $50 into this new checking account for a total of $65. If you would like us to debit your account at another financial institution to fund your new account, please fill out the fields below. If you leave these fields blank, a representative will contact you with additional options to fund your new account.

Financial Institution Name

Address of Financial Institution

Routing Number (ABA)

Account Number

Confirm Account Number

Enter Dollar Amount for Savings - min. of $15.00

If Checking Selected, Enter Dollar Amount - min. of $50.00

Note: Funds will not be withdrawn from the account until we have fully processed your new membership. **Approximately 2-3 business days.

Terms and Conditions

Please review the following information carefully. Please check the boxes upon acceptance.

Membership and Account Agreement

I Accept the Membership Agreement

Fee Disclosure

I Accept the Fee Schedule

Thank you! We will contact you within 24 business hours.

Click here for Business Hours