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Place of Employment:
Occupation:
Family Member’s Name:
Family Members SSN or
Share Account Number:
Member’s Name:
Member’s SSN or Share Account Number:
Primar
y:____ ____ ____ Secondary: ____ ____ ____
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
SECU Membership Information Form
Please provide the following information:
Primary Person Secondary Person (Joint)
Full Legal Name
Preferred Name
SSN
Date of Birth
Mailing Address
Cit
y, State, Zip
Residence Address City,
State, Zip
Driver License (state and
number)
Home Phone
Mobile Phone
Office Phone
Place of Employment
Occupation
How are you eligible for Membership?
Employment (enclose recent paystub)
Family Member (you must be the
s
pouse, child, parent, or sibling of an
SECU member
)
Relationship to you:
Spouse Child Parent Sibling
Single Economic Unit With
Member (enclose recent utility bill)
Account Type(s) Requested:
Share (required for membership; $25 minimum balance)
Checking (no minimum balance )
Money Market (required $250 minimum balance)
Please enter a 3-digit Voice Response Number. This will be
used as your password for the Voice Response Phone System,
as well as your initial password to enroll in Member Access:
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:
To help the government fight the funding of terrorism and money laundering activities, Federal law requires
all financial institutions to obtain, verify and record information that identifies each person who opens an account.
What this means for you: When you open an account, we will ask for your name, address, date of birth and other
information that will allow us to identify you. We may also ask to see your driver license or other identifying documents.
Date: _____________ Signature: ___________________________________________________________________________
Date: _____________ Joint Signature: ______________________________________________________________________
Complete this form and take it to your local branch, fax it to our 24/7 Member Services at (888) 732-8329 or (919) 857-2000, or mail it to: SECU
Member Services, PO Box 27963, Raleigh, NC 27611. If you fax or mail the form, a Representative will contact you with further information.
