BET FEDERAL CREDIT UNION

P.O. Box 474

Bronxville, New York 10708

MEMBERSHIP APPLICATION

Name: ______________________________________________________________

Home Address:

Street:_______________________________________________________________

City ________________________State ___________________Zip ______________

Home Phone (Include Area Code) _________________________________________

Social Security Number _________________________________

Birth Date ____________________________________________

School District _________________________________________

School Phone __________________________________________

Position _______________________________________________

Spouse's Name:  Husband's First ___________________________

                            Wife's Maiden ____________________________

If you wish a joint account, give the social security number and birth date of the joint owner.

Social Security # __________________________________________________________________

Birth Date _______________________________________________________________________

If you wish a payroll deduction for savings, indicate the amount per pay period $______________

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Return the completed application to the BET at the above address.

Upon receipt of  your application, the treasurer will be in touch with  you to complete

your application for membership.