Membership Application


To apply for Credit Union membership, simply fill out the information requested below, and click on the 'Submit' button.

Completing this form does not complete your application for membership. A CHACO Representative will contact you via email or phone to verify the application and complete the membership process.


* You must check this box in order to submit the application. By checking the box, you agree to the waiver below:

WAIVER: I understand that by sending this form over the Internet that my personal information may not be secure and I release our Credit Union and all its officials, employees, affiliates, subsidiaries, vendors, and assignees from any liability and/or loss that arises from using this form.

Note: If you feel more comfortable, you can print out this form, fill it out and mail it to us.
*First Name:
Middle Initial:
*Last Name:
*Street Address:
Apartment/etc.:
*City:
*State:
*Zip:
*Home Phone Number:
Work Phone:
*Social Security Number:
*Date of Birth:
*E-Mail Address:


I am eligible for membership through:

My Employer or Affiliation
Employer/Affiliation Name:
A Family Member who is a Credit Union Member or eligible to be a member.

Family Member's Name:

 
Anyone who lives, works, worships or attends school in Butler, Hamilton, Warren or Preble County.

Joint Owner Information:
If you would like a Joint Owner on your account, please
enter the following information:

First Name:
Middle Initial:
Last Name:
Street Address:
Apartment/etc.:
City:
State:
Zip:
Home Phone Number:
Work Phone Number:
Social Security Number:
Date of Birth:
Relationship:

Click on the 'Submit' Button to send us your Membership Application, or
the 'Clear Page' Button to clear the values entered and start again.

Completing this form does not complete your application for membership. A CHACO Representative will contact you via email or phone to verify the application and complete the membership process.