Untitled Document

UNIVERSAL
Federal Credit Union

Electronic Bill Payment
MEMBERS ENROLLMENT FORM

Print this page and fill out all applicable information. You may fax the form to our office at (304) 522-3177, mail the form to 317 31st Street, Huntington WV 25702 attn: Jason, or drop it by one of our offices.

**Member Section**
Name:
Social Security Number:
Email address:
Address:
City:

State:	Zip:
Joint Owner:	Joint Owner:
Type of Account: Share Draft	Account Number:

For Administrative Use Only