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Membership Application

* Indicates required field.

Application Requirements
Applicant Information
Tin Certification
  • Because Brokaw Credit Union is a not-for-profit financial cooperative, membership is required in order to utilize and enjoy its many financial services and benefits. If eligible, membership is as simple as depositing and maintaining a minimum of $5 in a Primary Savings Account under your name and social security number.

    (Applicants must be 18 years of age or older and must be U.S. citizens to apply online. Minors, resident alients and non-resident aliens may apply by contacting the credit union directly.)

    Application Requirements


    • Are you eligible *
    • How did you hear about us? *

    By completing this form, you are applying for membership in Brokaw Credit Union, and requesting a Primary Savings Account be opened in your name and social security number (If you are already a member and wish to open other accounts, please go to our online account application.)

    Important Information About Procedures for Opening a New Account: To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

    What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

    Application Type

    • Application Type *

    Account Type

    You may apply for additional account types at this time. All of the terms, conditions, form of account ownership, account selection and other information indicated on this card apply to all of the accounts unless the Credit Union is notified in writing of a change. A minimum deposit may be required for each additional account type opened.

    • Additional Accounts
  • Applicant Information

    • Phone Type *

    Joint Applicant

    • Phone Type *
  • TIN certification and backup withholding information

    Under penalties of perjury, I certify that: *

    1. The number shown on this form is my correct taxpayer identification number, and
    2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
    3. I am a U.S. citizen.

    If any of these statements is not true of you, please apply directly at the credit union.

  • Authorization

    If approved, to complete the account opening process, you must stop by Brokaw Credit Union within 30 days to present your unexpired government-issued photo ID, proof of address (if it is not current on your photo ID) and first deposit.

    Additional Information