Instructions:

1) Print this page.

2) Fill out the form by hand

3) Please fax, mail or bring into your nearest branch this application along with a copy of a valid picture ID with signature to process this request.

Fax to:

Phone Center => (305) 253-4124

Medical Center => (305) 324-8606

Red Road Main Branch => (305) 667-5086

Florida International University – University Park => (305) 348-1773

Florida International University – Biscayne Bay => (305) 919-5582

Mail to:

University Credit Union

13241 SW 136th Street

Miami, FL 33186

                                             e*branch Application Form

I (we) apply for e*branch and agree to the terms and conditions of the e*branch disclosure.

I agree to receive my periodic statements electronically by clicking on e-Documents.

Statements will be made available in the first five (5) business days after the end of the period.

University Credit Union Account Number: ____________________________________

E-mail Address: ________________________________________________________

Telephone Number: _____________________________________________________

Print Name: ___________________________________________________________

Signature: _____________________________________________________________

Date: ________________________________________________________________

Address: _____________________________________________________________

City, State and ZIP: _____________________________________________________

Print Joint Name: _______________________________________________________

Joint Signature: _________________________________________________________

Date: _________________________________________________________________