Secure Services Application
2318 W Willow Knolls Drive, Peoria, IL 61614
Phone: (309) 693-6000  •  Fax: (309) 693-7312
Please complete the form below, submit it, and you will receive a letter within three or four business days concerning your request. You may also call us at (309) 693-6000 or toll free at (800) 927-6003 for more information or to complete your request immediately.
Account Request
I am interested in opening the following KPCU accounts:
Share Account Certificate of Deposit Vacation Club Account
Checking Account Holiday Club Account Tax Club Account
Other   |  Explain:
I understand that completing and submitting this form will not open a KEMBA Peoria Credit Union account, but indicates my desire to establish and account with KPCU. Upon submission of this form, I understand that a KEMBA Peoria Credit Union Member Service Representative will contact me regarding my request to open an account with the credit union.
Services Request

I am applying for the following services:

Online Account Access E-Statements MasterMoney™ Debit Card
By submitting this request, I
acknowledge that I have read
& agree to the terms of the

By submitting this request, I
acknowledge that I will receive my
statements electronically as E-Statements.

By submitting this request, I
acknowledge that I have read
& agree to the terms of the
Home Banking Disclosure
E-Statement Disclosure
MasterMoney™ Debit Card Disclosure & Agreement
Personal Information
Name:
Account Number:
 
Address: 
Apt/Suite:
City, State, Zip:
Email:
Social Security Number:
Birth Date:
Additional Comments:

By submitting this application, I authorize KEMBA Peoria Credit Union to obtain a credit bureau report, if necessary, to determine credit worthiness. In order to protect your identity, Kemba will send you the necessary forms to complete the service you requested.

Submit Application