Primary Member's Name:

Street Address:

City/State/Zip:

Social Security Number:

Driver's License No.:

State(s) Resided Last 5 Years:

Joint Account Member Name(if applicable):

Joint Account Member Street Address:

Joint Account Member City/State/Zip:

Joint Account Member Social Security Number:

Joint Account Member Driver's License No.:

Daytime Telephone Number:

Email Address:

Please indicate the name of the Personal Banker (if applicable) that referred you to this online application:

Select One:

Freedom Checking
Corporate Direct
IncomePlus
Premier Checking/Premier Senior Checking
Premier Interest Checking/Premier Interest Senior Checking
Funtimers

Select below to order checks (note: please wait to order checks if you intend on adding a joint owner). To add a Joint Owner, I understand that a Membership Change Form must be completed, signed, and returned to the Bank for processing. Complete an Additional Services Form to have one mailed to you.

Please order checks

Check Style: Choose one Starting Check Number:

Indicate below if you are signing up for Direct Deposit
I WANT FASTER ACCESS TO MY CASH WITH DIRECT DEPOSIT. If you agree to try this convenient service, we'll give you your first box of select checks Free. All you have to do is complete a Payroll Direct Deposit Authorization form (available through your payroll department). You'll need the following information to complete the form: The bank's ABA Number (081204540), and your checking account number. Return the original Direct Deposit Form to your payroll department.

Indicate below if you are applying for a Checking Cash Reserve Line-of-Credit
Please open a $300 Cash Reserve. I understand, that there are no maintenance fees for this service and that finance charges accrue only when the line of credit is used. Please complete an All-In-One application if you would like a higher line of credit. I have also read & agree to the Cash Reserve Agreement.

Indicate below if you are applying for a Check Card
I would like to receive a Check Card.