* Indicates required field.

• Do you currently have a Primary Savings Account at BCU? If yes, continue on to initiate additional deposit accounts. If not, please instead visit our Online Membership Application.

  Account Information

  USA Patriot Act - Notice

  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's license or other identifying documents.

  Personal Information

  • Ownership Type *
    Individual Account Joint Account
  • Account Type *
    Freedom Checking Regency Checking Advantage Checking Money Market Account Secondary Savings Christmas Club Share Certificate Youth Savings

• Applicant Information

  • First Name *
  • Middle Initial
  • Last Name *
  • Email *
  • Mother's Maiden Name *
  • Social Security Number *
  • Date of Birth *
  • Physical Address *
  • Address 2
  • City*
  • State *
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Zip *
  • Mailing Address
  • Address 2
  • City
  • State
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Zip
  • Primary Phone *
  • Phone Type *
    Home Cell
  • Work Phone
  • Goverment Issued Photo ID *
    Driver's License Passport State-Issued ID Card U.S. Government ID
  • ID Number *
  • Issue Date *
  • Expiration Date *

  Beneficiary Information

  The owners of many accounts name payable-on-death (POD) beneficiaries for the accounts. That means that when the account owner (or the last surviving owner, in the case of a joint account) dies, the POD beneficiary can simply claim the money from the Credit Union. In most cases the deceased person's will does not come into play, nor is probate court involvement required.

  POD designations are widely used because they're simple both for the person who sets them up and the beneficiaries who inherit. Please indicate below if you would like to include a beneficiary at this time.

  • Would you like to designate a beneficiary? *
    Yes No

  Beneficiary 1

  • Beneficiary First Name
  • Beneficiary Last Name
  • Beneficiary Relationship
  • Beneficiary Address
  • Beneficiary Address 2
  • Beneficiary City
  • Beneficiary State
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Beneficiary Zip
  • Beneficiary Social Security Number
  • Beneficiary Date of Birth

  Beneficiary 2

  • Beneficiary First Name
  • Beneficiary Last Name
  • Beneficiary Relationship
  • Beneficiary Address
  • Beneficiary Address 2
  • Beneficiary City
  • Beneficiary State
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Beneficiary Zip
  • Beneficiary Social Security Number
  • Beneficiary Date of Birth

  Beneficiary 3

  • Beneficiary First Name
  • Beneficiary Last Name
  • Beneficiary Relationship
  • Beneficiary Address
  • Beneficiary Address 2
  • Beneficiary City
  • Beneficiary State
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Beneficiary Zip
  • Beneficiary Social Security Number
  • Beneficiary Date of Birth

  Beneficiary 4

  • Beneficiary First Name
  • Beneficiary Last Name
  • Beneficiary Relationship
  • Beneficiary Address
  • Beneficiary Address 2
  • Beneficiary City
  • Beneficiary State
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Beneficiary Zip
  • Beneficiary Social Security Number
  • Beneficiary Date of Birth

  Beneficiary 5

  • Beneficiary First Name
  • Beneficiary Last Name
  • Beneficiary Relationship
  • Beneficiary Address
  • Beneficiary Address 2
  • Beneficiary City
  • Beneficiary State
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Beneficiary Zip
  • Beneficiary Social Security Number
  • Beneficiary Date of Birth

  Remove Beneficiary Add Beneficiary

  Joint Applicant

  • First Name *
  • Middle Initial
  • Last Name *
  • Email *

    You must provide a valid email address to complete your application. We ask for your email address so we can send you important communications relating to your application. Please see our Privacy Policy for more details.

  • Social Security Number *
  • Date of Birth *
  • Address *
  • Address 2

    No P.O. Boxes please

  • City*
  • State *
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • Zip *
  • Primary Phone *
  • Work Phone
  • Cell Phone
  • Goverment Issued Photo ID *
    Driver's License Passport State-Issued ID Card U.S. Government ID
  • ID Number *
  • Issue Date *
  • Expiration Date *

• Authorization

  To complete the account opening process, please select your preference.

  • I will complete my account opening at *
    Brokaw Branch Weston Branch Please mail my documents
  • * As part of the account opening proccess, Brokaw CU may obtain information about you from a consumer reporting agency. Based on that information, you may or may not be approved to open the account. I authorize Brokaw CU to access consumer reports for me and any joint applicants in order to process this application.
  • Applicant authorization date *

  • Co-applicant authorization date *

  Additional Information

  • For BCU to obtain additional information, if required, how would you prefer to be contacted? *
    Select One Email Phone
  • Special Instructions/Comments