CREDIT UNION ONLINE ACCESS AUTHORIZATION FORM

---

Please Note: This form is for first-time enrollment for online account access. If you are enrolled (if you've ever been signed-on to your account online before), please do not use this form, and instead please call us, or e-mail us with a description of the trouble you are having. I agree to the Disclosure of Terms and Conditions of Home Banking.

I authorize USHEFCU to activate the following account(s) on the computer Home Banking system. I understand that the account(s) listed below will be accessible to me through Home Banking.

Account Information:
Share Account# 1:		Share Account# 4:
Share Account# 2:		Share Account# 5:
Share Account# 3:		Share Account# 6:

USHEFCU may notify me by e-mail that my account(s) has been activated.

Contact Information:
Your Name:*
Your E-Mail:*
Printer Friendly Form	(in case you'd rather print, complete, & bring in to us)