New Member Information Form

Fields marked with an asterisk (*) are required.

First Name *

MI

Last Name *

Address *

City *

County *

State * — Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Home Phone Number * Please include area code

Cell Phone Number * Please include area code

E-mail Address *

Preferred Location Which WESTconsin Credit Union office do you visit the most? Altoona Office Amery Office Baldwin Office Barron Office Chippewa Falls Office Eau Claire Office Ellsworth Office Hudson Office Menomonie-Downtown Office Menomonie-East Office Menomonie-North Office Menomonie - Business Center New Richmond Office Prescott Office River Falls Office

Contact Method Please choose your preferred method of contact Phone E-mail

When is the best time to contact you? *

At which phone number Please choose your preferred method of contact Home Phone Cell Phone

You are eligible to join WESTconsin Credit union by living or working within our field of membership service area that includes the following counties:
Wisconsin—Barron, Buffalo, Burnett, Chippewa, Clark, Dunn, Eau Claire, Jackson, Pepin, Pierce, Polk, Rusk, St. Croix, Sawyer, Taylor, Trempealeau and Washburn
Minnesota—Anoka, Chisago, Dakota, Goodhue, Hennepin, Isanti, Pine, Ramsey, Scott, Wabasha, and Washington

Do you live in any of the counties listed above? Yes No

Products/Services I am interested in: Savings Account Certificates Individual Retirement Account (IRA) Money Market Accounts Checking Account Health Savings Account (HSA) Debit Card Visa credit Card Online Banking Vehicle Loan (New or Used) Personal/Signature Loan Direct Deposit or Payroll Deduction Life Insurance Investments Mortgage Loan or HELOC Business Loan Business Checking Business Savings

Do you intend to add any joint owners to your account? Yes No