Internet Teller Enrollment Form
946 East Third Street, Chattanooga, TN 37403
Phone: (423) 242-4728 • Fax: (423) 242-1940

NOTE: If you already have an access code but are locked out, please DO NOT reapply for access. Instead CLICK HERE. You MUST currently be a Healthcare Services Credit Union member to complete this form! The information requested below is for the primary member on the account.

Member Information

Member Account Number:

First Name:

Middle Name/Initial:

Last Name:

Last 4 Digits Of Social Security #:

Birthdate (MM/DD/YYYY):

Email Address:

Street Address:



Zip Code:

Home Phone #:

Cell Phone #:

Work Phone #


Submit Form

By submitting this request, I acknowledge that I have read and agree to the terms of the Home Banking Disclosure