Platinum Money Market

Personal Information

Are you a new member? *

Yes

Social Security Number *

Date of Birth *

Home Phone *

Daytime Phone

Mother's Maiden Name *

Email *

Contact Information

Choose the location you would like to complete your application *

How would you prefer to be contacted? *

Phone

Mail

When is the best time to arrange an appointment? *

Morning

Lunchtime

Afternoon

Address Information

Residential Address (Not a P.O. Box) *

City *

State *

Zip Code *

Use residential address for mailing address? *

Yes

Joint Account Information

Number of Joint Owners on this Account? *

Comments *

Park City Credit Union reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.