Membership Application

Membership Application

A complete description of all accounts & services are listed in the Products & Services section of this site. Please provide all the requested information. When you have completed the form, press the SUBMIT button to send your application to Choice for processing. Each application will be checked for membership qualification, and verification. You will receive verification through the mail with a complete signature card within seven to ten mailing days. You will be requested to provide a CLEAR copy of your valid Drivers License or State ID, to read and sign the signature card, and provide a check for at least the minimum required amount for EACH account requested.

Primary Applicant

Name:

                             First                                             Mi.                                                     Last
Mailing Address:

                                     Street                                                                     City

State                   Zip code

Soc. Sec. Number:        Birth Date:


Home Phone:                Work Phone:                      Cell Phone:                  Email:

        area code                                         area code                                        (optional)                                   (optional)

To Qualify for membership please check one of the following:
I Am

Living in Guilford County

Working in Guilford County - Company Name:

Worshiping in Guilford County - Church Name

Attending School in Guilford County - School Name

Or:
I Am

Employee of Existing Member Company

Plant location

Retiree of Existing Member Company

Plant location

Family Member of:

Primary Member's Name Primary Member's Soc. Sec. Number

I hereby apply for membership in CHOICE COMMUNITY CREDIT UNION, and agree to conform to its bylaws and amendments. "Under the penalties of perjury, I certify that the number shown on this form is my correct identification number and that I am not subject to backup withholdings either because I have not been notified that I am subject to backup withholdings as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding."