Hoosier Hills Credit Union - E-Statement Registration

You may submit this application electronically, or you may fill it out, print it, and mail it to:
Hoosier Hills Credit Union
630 Lincoln Avenue
Bedford, IN 47452

Fields marked with an asterisk (*) are required fields.

E-statement Registration

Member Number:*      

First Name:*              

Last Name:*              

Street Address:*         

City, State, Zip:*        

E-mail Address:*       
  (e-mail is case sensitive, please use proper lettering) 

SSN or Tax ID:*

By signing or submitting this form I authorize HHCU to discontinue sending me statements via the U.S. Postal Service, and begin sending my statement information via e-mail. I understand that the statement information will be encrypted and password-protected for my security and that I am responsible to alert the credit union of any changes in my e-mail address. I also understand I may receive additional messages from HHCU.
Click for HHCU's Privacy Policy.

_______________________________________________        _______________________  
Signature                                                                             Date
     

* Acrobat Reader 4.05 or greater is required to view your statement.
* For security reasons, e-statements can only be accessed using a web 
  browser that supports 128-bit encryption.
* E-statements are not compatible with Web TV.

  
For Office Use Only:
Entered into database by ___________________________   __________
                                                 (teller #, initials)                    (date)