United Savings Credit Union -- Secure Home Banking Sign Up Form

	Secure Home Banking Sign Up Form P.O. Box 2308, Fargo, ND 58108 Phone: (701) 235-2832 • Fax: (701) 235-8376

You must currently be a United Savings Credit Union member to complete this form!
The information requested below is for the primary member on the account.

All Fields Are Required

Member Account Number:
Email Address:
First Name:
Middle Name or Initial:
Last Name:
Street Address:
City:
State:	Zip:
Home Phone #:
Cell Phone #:
Work Phone #:	Ext:
Last 4 of Social Security #:
Birthdate (MM/DD/YY):

	By submitting this request, I acknowledge that I have read and agree to the terms of the Online Services Disclosure