Member Connect Application

You may use this form to sign up for RVCUs telephone account access system.  The form must be completed, signed, and mailed or faxed to RVCU.  Your temporary PIN will then be mailed to the primary account holder at the address listed on the account.

Name    _______________________________________

Address    ______________________________________

City    ____________________  ST ____  Zip _________

Home Phone No.    _______________________________

Account No.    ___________________________________

By signing below, I certify that I am the named owner of the above
account and therefore have the authority to request this service.

Signature    _____________________________________

Date    ______________

Mail to:
Roanoke Valley CU
Attn:  Member Service
P. O. Box 13045
Roanoke, VA  24030

or Fax to:
(540) 982-3937