Membership Form
110 Wagner Rd. Petersburg, VA 23805
Phone: (804)748-3081  •  Fax: (804)518-0766


How To Join
  1. Complete the following On-Line Membership Application Request Form and submit it.
  2. Once received, we will mail to you a pre-filled application form requiring your signature and the signature(s) of your joint owner(s) (if applicable).
  3. The signed Membership application must be returned to the credit union along with an initial deposit of at least $5.00 and / or direct deposit form, and a copy of a government issued photo ID & Social Security Card for the application process to be completed.

Applicant Information
First Name: MI: Physical Address :
Last Name: City : State:
Date of Birth: Zip :
Mother's Maiden Name: Mailing Address :
Social Security #: City : State:
Driver’s License # : Zip :
Driver License Issue Date : Home Phone :
Driver License Expiration Date : Business Phone :
Driver License State of Issue : Employer:
Email Address : Occupation / Title:

Beneficiary(s)
Name Social Security Relationship











Membership Eligibility (Check all that apply)

Live, work, worship or attend school in the following:

Immediate family of any existing member
I work for : Health Care Education Public Service Genworth Honeywell Other :

How did you hear about us?
Referral from friend, family or co-worker
Website
Mail
 Drove
Other:

Submit Application

Preferred branch location for closing loan?

I/We understand that credit union membership is required to fully process this loan application and further documentation / signatures may be required. By submitting this form with your electronic signature(s), you agree that everything stated in this application is correct to the best of your knowledge and grant permission to Peoples Advantage Federal Credit Union to perform the following. PAFCU is authorized to validate your information, investigate your creditworthiness, employment history, and obtain a credit report. You understand that any false or misleading statement in your application may cause any loan or extension of credit to be in default. You authorize us to accept your facsimile signatures on this application and agree that your facsimile signature will have the same legal force and effect as your original signature. You assume any risk that may be associated with permitting us to accept your facsimile signature. PAFCU may keep this application whether or not it is approved.

By pressing the "Submit Application" button below, you agree to the above statement.     

To avoid delays in processing your request please provide us with the best method and time to contact. Best method of contact:
 Home Phone      Mobile Phone      Work Phone              What time of day is best to call:


Date:
 Primary Signature:
 Joint Signature:
Enter The Security Code Displayed In The Box Below:
[858932]