Membership Application - University of Utah Credit Union

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membershipapplication
Apply for membership with University of Utah Credit Union

Complete this form, print it out and bring it to any of our branch locations. Credit Union membership contingent upon eligibility.

ELIGIBILITY

Check all
applicable boxes:

Live, Work, Attend School, Worship, or Volunteer in Salt Lake County

Immediate family member of a credit union member or eligible member:

University of Utah Credit Union Employee

	ACCOUNT INFORMATION
	This application is for: (Check all that apply)	Savings Checking Secondary Share Money Fund Christmas Club Certificate of Deposit

	APPLICANT INFORMATION
	Name:
	Street Address (No PO Boxes):	(If Salt Lake County residence is basis for membership, a Salt Lake County address must be provided.)
	City:
	State:
	ZIP Code:
	Phone with Area Code:
	Mailing Address (If different from street address):
	City:
	State:
	ZIP Code:
	EMail Address:
	Social Security Number:	(123-45-6789)
	Date of Birth:	(MM/DD/YY)
	Mother's Maiden Name
	Employer:	Self Employed
	Employer Phone with Area Code:	(XXX-XXX-XXXX)

	CO-APPLICANT INFORMATION
	Name:
	Street Address (No PO Boxes):	(If different from applicant.)
	City:
	State:
	ZIP Code:
	Phone with Area Code:
	Mailing Address (If different from street address):
	City:
	State:
	ZIP Code:
	EMail Address:
	Social Security Number:	(123-45-6789)
	Date of Birth:	(MM/DD/YY)
	Mother's Maiden Name
	Employer:	Self Employed
	Employer Phone with Area Code:	(XXX-XXX-XXXX)

	ADDITIONAL APPLICANT INFORMATION
	Name:
	Social Security Number:	(123-45-6789)
	Date of Birth:	(MM/DD/YY)
	EMail Address:
	Employer:	Self Employed
	Employer Phone with Area Code:	(XXX-XXX-XXXX)

	CLOSEST RELATIVE (Not Living With Applicant)
	Name:
	Relation:
	Street Address:
	City:
	State:
	ZIP Code:
	Phone with Area Code:

SECTION TO BE COMPLETED AT BRANCH

	Member Signature	Joint Signature

	Account Number	Date
Information below to be completed by a Credit Union Representative Chex Systems Verified Social Security Issue Date: Member Joint: Branch: Employee #: Manager Initials: Date:

MEMBERSHIP

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