Secure Home Banking Sign Up Form
1705 Centennial Blvd #4, Springfield, OR 97477
Phone: (541) 746-6121 • Fax: (541) 746-4486

You must currently be a McKenzie Valley Federal Credit Union member to complete this form!
The information requested below is for the primary member on the account.
MEMBER INFORMATION
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 Digits of Social Security #:
Birthdate (MM/DD/YYYY):
/ /
ONLINE SERVICES DISCLOSURE
  By submitting this request, I acknowledge that I have read and agree to the terms of the Online Services Disclosure