Share Certificate Application

* Indicates Required

Ownership Information

First Name*

Middle Initial

Last Name*

Home Phone

Cell Phone

Work Phone

Ext.

Contact Preference*

Date of Birth*

Home Address *

Address Line 2

City *

State *

Zip *

E-Mail Address*

Amount of Certificate $*

Choose Term Desired*

6 Months 12 Months 24 Months

Term Desired is required

Comments or Special Needs

Please see Share Certificate Terms & Agreement for more information.

By checking here, I authorize the FirstEnergy Family Credit Union, Inc. to make a one-time transfer of funds from my share account to my share certificate account. The credit union will send your certificate and receipt in the mail once processed. You will be notified if your request cannot be processed.

Authorization Notice: By submitting this application to the credit union, you certify that everything you have stated in this application is correct to the best of your knowledge. All submittals are subject to verification of the information provided. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on applications made to Credit Unions insured by NCUA.