Authorization for CU Online and/or PC Bill Pay

- - PLEASE PRINT AND RETURN - -

Member Name: _____________________________ Member #: ___________________

Address: _______________________________________________________________

City: ______________________________________ State: _______ ZIP:____________

Home Phone: (_______)________________ Work Phone: (_______)________________

Email Address: ___________________________________________________________
(Required for enrollment notification. Please print legibly to avoid delays.)

________Please sign me up for CU Online (online banking).
All shares and loans under the member number listed above will be accessible.


Other accounts I wish to transfer into are:

Name: _______________________________________ Member #:_________________________

Name: _______________________________________ Member #:_________________________

Name: _______________________________________ Member #:_________________________

____________________________________________________________________________________________________

________Please sign me up for PC Bill Pay
(you must have a St. Agnes Credit Union checking account in order to use PC Bill Pay)

I agree to receive all agreements and initial disclosures electronically. After I have carefully read the agreement in its entirety, I will be asked to consent to the terms and conditions of the agreement.

Signature:______________________________________ Date: _______________
(Member only must sign.)

Please drop off this completed application to either SAEFCU office or mail to: St. Agnes Employees Federal Credit Union, Attn: Marketing Dept., 720-E Maiden Choice Lane, Baltimore, MD 21228, or FAX to (410) 869-8293. You will be notified when your service(s) are activated.