New Member Enrollment Form

Would you like to become a member of CUCCU?

Membership is simple, and available to anyone working at Credit Union Consultants, employees of the Credit Union and members of the immediate family.

Come visit us at your most convenient branch and our member service representatives will be happy to help you with enrollment, or simply fill out the form below and one of our member service representatives will contact you before the end of the next business day to assist with completing enrollment.

All fields highlighted by red asterisks (*) are required fields.

*Full Name

*Address 1

Address 2

*City

*State

*Zipcode

*Phone#

*Email Address

*Social Security Number

*Drivers Licence Image (JPEG Image, < 10MB)

Comments

Terms/Conditions

Member Identification Requirements

In accordance with Section 326 of the USA Patriot Act, applicants for new accounts are requested to provide current picture identification that verifies identity including name, address, and other identifying information.

In some cases, identification will be requested for current account holders if original documentation was not obtained with the opening of the account. In all cases, protection of our members’ identity and confidentiality is our pledge to you.

Monetary Requirements

A $5.00 initial deposit is required to gain a "share" of the credit union. This deposit must be maintained to retain membership qualifications.

I accept the above terms/conditions