Beaver Valley FCU Membership Application

Thank you for your interest in becoming a member of Beaver Valley Federal Credit Union.. If you live, work, worship, or attend school in Beaver County, Pennsylvania, or are part of the immediate family or household of someone who qualifies for membership, you may become a credit union member.

To apply for membership, just complete the following application, print it out and mail it to us along with your initial deposit of at least $5. (This is not a fee, but a deposit into a regular share account.) This initial deposit entitles you to take advantage of a full range of financial services provided by BVFCU.

You are also required to provide positive identification; a clear photocopy of your valid Driver's License and Social Security Card. After your account is opened, you will be mailed a copy of your membership agreement containing your new BVFCU Account Number. Click here for U.S. Patriot Act disclosure.

Mail your completed form, check (or money order) and ID to:

Member Services

Beaver Valley FCU

601 - 37th Street

Beaver Falls, PA 15010

Membership Qualification

I am eligible for membership in BVFCU because I :
OR
A member of my household or immediate family :

Live in Beaver County
Work in Beaver County
Worship in Beaver County
Attend school in Beaver County

Name of family or household member if eligibility for credit union membership is through the individual

Primary Owner of Account

Last Name:

First Name:

Maiden Name:

Home Address: (Not P.O. Box)	City:	State:	Zip Code:
How long have you been at this address? mo years, If less than 6 months,
Previous Address: (Not P.O. Box)	City:	State:	Zip Code:

Social Security Number

Date of Birth:

Home Phone Number: (with area code)

Employer Name
Employer Address

Mother's Maiden Name

Driver's License Number:

State:

Personal Contact (Relative or close personal friend not living in the same household.)
Name:	Relationship:	Phone Number:

Joint Owner #1

Relationship to Primary Member:

Last Name:

First Name:

Home Address: (Not P.O. Box)

City:

State:

Zip Code:

Social Security Number

Date of Birth:

Home Phone Number:

Mother's Maiden Name

Driver's License Number:

State:

Joint Owner #2

Relationship to Primary Member:

Last Name:

First Name:

Home Address: (Not P.O. Box)

City:

State:

Zip Code:

Social Security Number

Date of Birth:

Home Phone Number:

Mother's Maiden Name

Driver's License Number:

State:

Joint Owner #3

Relationship to Primary Member:

Last Name:

First Name:

Home Address: (Not P.O. Box)

City:

State:

Zip Code:

Social Security Number

Date of Birth:

Home Phone Number:

Mother's Maiden Name

Driver's License Number:

State:

Back-up Withholding Certification

I certify under penalties of perjury that the Taxpayer Identification Number shown above is my correct TIN and I am not subject to backup withholding either because (a) I have not been notified by the Internal Revenue Service that I am subject to backup with- holding as a result of a failure to report all interest or dividends or (b) the IRS has notified me that I am no longer subject to backup withholding.

X________________________________
Member Signature

______________________________________________
Print Full Name of Primary Member

X________________________________ Member Signature	X_________________ Date
X________________________________ Joint Owner #1 Signature	X_________________ Date
X________________________________ Joint Owner #2 Signature	X_________________ Date
X________________________________ Joint Owner #3 Signature	X_________________ Date