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Secure Membership Enrollment Form

833 Washington St., Reading, PA  19601
Phone: (610) 373-3840  •  Fax: (610) 373-4479

How To Join:
  1. Complete the following On-Line Membership Request Form (below) and submit it.
  2. Once received, we will mail you a completed Membership Application/Signature Card for your signature and your joint owners signature (if applicable).
  3. The signed Membership/Signature Card must be returned to the credit union along with $6.00 ($5.00 minimum deposit plus one-time $1.00 membership fee) for the process to be complete.

The Membership/Signature card you will sign includes the following statements and agreements:

I hereby make application for membership in Pagoda Federal Credit Union, and agree to conform to its bylaws and amendments thereof, and to subscribe for at least one (1) share. The Pagoda Federal Credit Union is hereby authorized to recognize any of the signatures subscribed hereto in the payment of funds or the transaction of any business for this account. The joint owners of this account hereby agree with each other and with said Credit Union that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said joint owners to their credit as such joint owners with all accumulations thereon, are and shall be owned by them jointly, with right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge said conditions of the account as established by the Credit Union from time to time. Any or all of said joint owners may pledge all or any part of the shares in this account as collateral security to a loan or loans from this Credit Union. The right, or authority of the Credit Union under this agreement shall not be changed or terminated by said owners, or any of them, except by written notice to said Credit Union which shall not affect transactions theretofore made.

Under the penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number and (2) that I am not subject to backup Withholding either because I have not been notified that I am subject to back up withholding as a result of a failure to report all interest or dividends, OR THE Internal Revenue Service has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including a U.S. resident alien).

Protecting Children's Online Privacy:
We do not knowingly collect, nor is our Home Banking site designed or directed, to use personal information from children under the age of 13 without containing verifiable consent from their parents. Should a child whom we know to be under the age of 13 send personal information to us, we will only use that information to respond directly to that child, seek parental consent or provide parental notice.

All Fields Are Required
Has the I.R.S. notified you that you are subject to back-up withholding of dividends or interest?

What account type(s) are you interested in (Note: $5 Share required)? Share/Savings Account
Draft/Checking Account
Time/Certificate Account
Club Accounts
IRA Account

Email Address:
First Name:      MI:
Last Name:
Street Address:
Social Security #:
Birthdate: MM/DD/YY
Home Phone #: 1234567890 (no separators)
Business Phone #:
Drivers License #:    State:
Mothers Maiden Name:

Complete The Following If There Is To Be A Joint Owner On Your Account
Joint First Name:      MI:
Joint Last Name:
Joint Social Security #:
Joint Birthdate: MM/DD/YY


Membership Eligibility (Check all that apply):
I live, work, worship, or attend school in or a business and other legal entities in Berks County, Pennsylvania.
Related to Current Member

How did you hear about us?
Friend/Family - Name:

Submit Application

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