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Online Membership Application

Please complete the membership application below to apply for membership with Parishioners Federal Credit Union. We will promptly review your membership application.

I'm eligible to join Parishioners Federal Credit Union because I'm... (please select an item from one of the choices below and provide the additional relevant information in the field below the choices). Note: An* indicates a required field that must be completed before submitting your application.

Eligibility (Provide necessary information in parenthesis)

Eligibility*

A Parishioner of (Parish Name)
A relative of a PFCU Member (First and Last Name)
Employed by (Employer)
Dept. of Catholic Schools (School Name / Deanery)

Eligibility Details*

Membership Applicant Information

Primary Applicant Information

First Name*
Middle Initial
Last Name*
Date of Birth*	(format mm/dd/yyyy)
Social Security No.* Social Security No.* Social Security No.*	- -
Driver License # or other ID*
Driver License State*
Mother's Maiden Name*
Home Phone*
Cell Phone
E-mail Address*
Street Address*
City*
State*
Zip*
Years at Current Address*
Type of Housing* Type of Housing* Type of Housing*	Rent Own Live at Home
Monthly Housing Cost*
Employment Status*
Employer*
Employer Address*
Employer City*
Employer State*
Employer Zip*
Job Title*
Work Phone*
Hire Date*	(format mm/dd/yyyy)
Gross Monthly Income (before taxes)* $
Other Income $
Source of Other Income
Previous Employment (up to 3 years)*

Co-Applicant Information Joint Owner Information (These fields are required only if there is a Joint Owner)

First Name*
Middle Initial
Last Name*
Date of Birth*	(format mm/dd/yyyy)
Social Security No.* Social Security No.* Social Security No.*	- -
Driver License # or other ID*
Driver License State*
Mother's Maiden Name*
Home Phone*
Cell Phone
E-mail Address*
Street Address*
City*
State*
Zip*
Years at Current Address*
Type of Housing* Type of Housing* Type of Housing*	Rent Own Live at Home
Monthly Housing Cost*
Employment Status*
Employer*
Employer Address*
Employer City*
Employer State*
Employer Zip*
Job Title*
Work Phone*
Hire Date*	(format mm/dd/yyyy)
Gross Monthly Income (before taxes)* $
Other Income $
Source of Other Income
Previous Employment (up to 3 years)*

Beneficiary(ies) Information

Beneficiary(ies) In the event of death, or if there is more than one owner of this account, in the event of death of all the owners, the owners hereby designate as my/our beneficiary(ies) to receive all the sums in my/our account established on this form.

Beneficiary One

First Name
Middle Initial
Last Name
Date of Birth	(format mm/dd/yyyy)
Social Security No. Social Security No. Social Security No.	- -
Home Phone
Street Address
City
State
Zip

Beneficiary Two

First Name
Middle Initial
Last Name
Date of Birth	(format mm/dd/yyyy)
Social Security No. Social Security No. Social Security No.	- -
Home Phone
Street Address
City
State
Zip

Choose Service and Indicate Initial Deposits

One-time Membership Fee	$5.00
Deposit to Savings Amount* (Minimum Deposit $5.00)
Share Checking (Yes/No)* (Minimum Deposit $20.00) *	Yes No
Amount of Initial Share Deposit* (Minimum Deposit $20.00)****
If share checking is selected a MasterMoney Debit Card and checks will automatically be issued. * First order of basic style checks free if you are age 55 or older or if you have an initial deposit of $300 or more. **** Accounts must pass ChexSystem and ID Flag to qualify for a Savings or Share Checking account.

Social Security Number/Taxpayer I.D.

Under penalties of perjury, I certify that: (1) the number shown below on this form is my correct Taxpayer Identification Number, (2) I am not subject to backup withholding because:
(a) I am exempt from backup withholding, or
(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or
(c) the IRS has notified me that I am no longer subject to backup withholding, and
(3) I am a U.S. citizen (including a U.S. resident alien).

Taxpayer ID*

Service Options and Additional Information

Overdraft Protection* **	Yes No
MasterMoney Debit* * **	Yes No
ATM Card* ***	Yes No
Overdraft Protection - Overdrafts for checking accounts only will be covered by an advance from my Line of Credit, subject to terms and conditions of that account, up to my credit limit, then by a transfer from my savings account. * Master Money Debit Card - If I do not qualify for a Master Money Debit Card, I will be issued an ATM card upon my request. **** In order to qualify for a "MasterMoney Debit Card", you have to have a Share Checking Account.

Materials Request (Control or Command Click to select multiple items)

Additional Materials

IMPORTANT PLEASE READ

Only click the "submit button" once. Please be patient and do not use the STOP or BACK buttons to interrupt this process if it is slow. Depending upon your connection speed and internet traffic, this application submission process will require anywhere from several seconds to a couple of minutes to complete.

Thank You.