Checking Application - Reliance Federal Credit Union

Applicant First Name *

Please provide all of the requested information. If you are a Co-Applicant, please list your name here.

Applicant Middle Name

Applicant Last Name *

Applicant Type *

Primary
Co-Applicant #1
Co-Applicant #2

Please complete an additional form for each Co-Applicant.

If a Co-Applicant, please list the name of the Primary Applicant

Initial Deposit Amount

Where is the initial deposit coming from?

I will mail a check or money order
I will transfer funds from another financial institution
Please transfer from another Reliance FCU account
Other

Initial Deposit Instructions

If transferring from another Reliance FCU account, please enter the account number above; OR if Other, please enter the means by which you plan to make the deposit.

I am also interested in:

Please select all that apply

If Other, Please List

Applicant Member Number *

Birth Date *//

Home Phone *

Work Phone

Mobile Phone *

Email *

Email

Confirm Email

Home Address (not P.O. Box) *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Contact Method

Home
Work
Mobile/Cell
Other

Special Instructions/Comments

610-783-5229 or 800-458-7004

20102 Valley Forge Circle

8704 Crispin Street

Checking Account Application