Membership Application

The type of Account I want to open:		All members must open and maintain a $25.00 Savings account.

Membership Eligibility
I am eligible for membership by: Choose only one of the following choices listed below for eligibility. (Click here to see our eligibility requirements)
1. I am an employee, retiree or volunteer of Maricopa County
Maricopa County Dept Name

2. I live, work or worship in Downtown Phoenix, the area of 7th Ave to 24th St, McDowell to Van Buren

3. I live, work or worship in MariSol's Mesa neighborhood (click here for a map)

4. I am an employee, or family member of an employee, of Mesa Community Action Network, Inc. (MesaCAN), or New Leaf (formerly PreHab of Arizona)

5. I am a member of the Arizona Odd Fellows and Rebekah organization in the State of Arizona and New Mexico (MariSol FCU merged in June 2006 with the Arizona Oddfellows and Rebekah CU)

6. I am a member of a Catholic Church: (MariSol FCU merged with a Catholic membership based credit union in 2002)
Parish or Church name
7. A family member is a member (any relation of a member is eligible)

Primary Account Owner
Last Name	First Name
Email Address	Date of Birth
Residence Address: (No PO Boxes, however you may use a PO Box for your mailing address)
Address Line 1	Address Line 2
City	State
Zip

Phone Numbers: (Be sure to include all area codes)
Home Phone	Work Phone
Cell Phone

Identification needed – you must have a social security number or tax payer ID to apply:
Social Security #	Tax ID # (If Applicable)

A secondary form of ID is required to meet US Patriot Act regulations. You will need to supply us with copy of this ID within 30 days of opening your account or your account may be subject to closure:
Drivers License #	State
Other ID
Other ID Number
Mother's Maiden Name

Mailing Address (if different from residence - can be PO Box)
Street Address	Apt #
City	State
Zip

Joint Account Owner
Last Name	First Name
Email Address	Date of Birth
Residence Address: (No PO Boxes)
Address Line 1	Address Line 2
City	State
Zip

Home Phone	Work Phone
Cell Phone

Social Security #	Tax ID # (If Applicable)
Drivers License #	State
Other ID
Mother's Maiden Name

Initial Deposit and Payment Method
Amount:	Minimum Balances: Savings - $25.00 Money Market - $2500.00 Student checking - $100.00
Method

Credit Card/Debit Card
Card Type	Card Number
Expiration Date	Credit Card CVV Code
Name on Card
Billing Address	City
State	Zip

My Current MariSol Account (if applicable)
Account #	Account Type

Make Deposit At Branch (Click Here for branch location information)


Send a check:
MariSol Federal Credit Union 721 N. 3rd Street Phoenix, AZ 85004
Electronic Signature: Please click here for a full copy of your Truth-In-Savings Disclosure and Account Terms and Conditions. Please fill in your full name to acknowledge you have read and accepted these terms and conditions: First Name: - Last Name:
Any other information that MariSol needs or comments? (If Applicable):