HEALTHCARE
1st
Federal Credit Union

 The Western Maryland Health System
Serving the Western Maryland Health System
Located at the Memorial Hospital Campus
of Cumberland, Maryland

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 View of The Narrows in Cumberland, Maryland
The Narrows
Cumberland, MD

Membership Application
Please provide all the requested information. When you have completed the form, click on the SUBMIT button to send your application. Your membership information will arrive in 2-4 days.

Primary Owner of Account

Membership Eligibility: I am eligible for membership because I (select one)

 WMHS Employee (Employer's Name)

Related to a Member or Potential Member (Family Member's Name and relationship to them)
     

Last Name

First Name

Middle Initial

 

Residence Address
(not P.O. Box)

City

State

ZIP

 

Mailing Address
(if different)

City

State

ZIP

 

Social Security No.(TIN)

Driver's License No.

State

 

Home Phone No.

Work Phone No.

Date of Birth

 

E-Mail Address

 

I Am / Am Not Subject to back-up withholding

 

Please Establish a Membership Password

(4-8 characters)

 

JOINT OWNER 1

Last Name

First Name

Middle Initial

 

Residence Address
(not P.O. Box)

City

State

ZIP

 

Mailing Address
(if different)

City

State

ZIP

 

Social Security No.(TIN)

Driver's License No.

State

 

Home Phone No.

Work Phone No.

Date of Birth

 

Relationship to Primary Owner

 

JOINT OWNER 2

Last Name

First Name

Middle Initial

 

Residence Address
(not P.O. Box)

City

State

ZIP

 

Mailing Address
(if different)

City

State

ZIP

 

Social Security No.(TIN)

Driver's License No.

State

 

Home Phone No.

Work Phone No.

Date of Birth

 

Relationship to Primary Owner

To establish membership at HEALTHCARE 1ST Federal Credit Union, a $10 minimum deposit into a savings account is required. This is your "share" in the credit union.

I would like to open:

Savings ($10 min. deposit required)
Checking

Basic Checking (No minimum deposit required)

ACCOUNT FUNDING

By Check
I will send a check within 10 days in the amount of to HEALTHCARE 1ST Federal Credit Union, 600 Memorial Avenue, Cumberland, MD 21502

By Transfer
I (we) hereby authorize the HEALTHCARE 1ST Federal Credit Union to initiate a debit entry to my (our) specified checking/savings account at the financial institution listed below, and, if necessary, initiate adjustments for any transactions credited/debited in error. This authorization will be effective no earlier than Thirty (30) Days from the day this authorization is initiated and will remain in full force and effect until HEALTHCARE 1ST FCU has received written notification from me (us) to terminate and revoke. I (we) agree and understand that any cancellation and revocation will be effective no sooner than thirty (30) days after receipt of written notification as to afford HEALTHCARE 1ST FCU reasonable opportunity to act on it. I (we) further agree that if any transfer is dishonored, whether with or without cause and whether intentionally or inadvertently, shall be under no liability to HEALTHCARE 1ST FCU whatsoever.

I wish to Debit the following institution:
           (withdraw)

(Name of Financial Institution)

Amount:
Account No.



(Address - City, State & Zip)

Please execute this request on:

(Signed application needed at credit union before transfer can be processed)

ABA Routing No.
(First 9 numbers from the left on the bottom of your checks)


I understand that this service may be revoked by HEALTHCARE 1ST FCU with or without prior notice of any kind should any transaction amount not be paid or honored upon presentment for any reason. If the credit union revokes this service I understand that I will be restricted from reapplying for this service for a period of sixty (60) days. Further, HEALTHCARE 1ST FCU is under no obligation to notify the undersigned individual(s) as to the non-payment of any such transfer request. 

ADDITIONAL SERVICES DESIRED

Visa Check Card - Primary Owner
Visa Check Card - Joint Owner

Please indicate any other services you are interested in at this time:

By submitting this form, I/we agree that I/we are within the field of membership and that the information given above is true and correct to the best of my/our knowledge. I/we understand that knowingly and willfully providing false information to the Credit Union is a Federal criminal offense (Title 18 U.S.C. 1001). Further, I/we authorize HEALTHCARE 1ST Federal Credit Union to obtain debit and/or credit information for the purposes of establishing membership.

Please note: After you submit the membership application, HEALTHCARE 1ST Federal Credit Union will print a copy and send it to you. In order to keep your membership open, please have all owners sign the application and send back to HEALTHCARE 1ST Federal Credit Union within 10 days. A return envelope will be provided.

_______________________________

_______________________________

_______________________________

(Name - PLEASE PRINT)

(Signature)

(Date)

_______________________________

_______________________________

_______________________________

(Name - PLEASE PRINT)

(Signature)

(Date)

 

 

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Copyright © 2006-2008 HEALTHCARE 1st Federal Credit Union
Website address:  http://www.healthcare1fcu.org
Last modified: October 15, 2008