Bethlehem 1st Federal Credit Union Logo Virtual Branch® Enrollment Application
Please note: Since this form requires a signature, you cannot submit it over the Internet.
You must present a printed and signed form to the Credit Union.
Click here for terms and conditions for Virtual Branch®.
Access to Services:
You are applying for enrollment in the Virtual Branch® Home Banking Services with access via the Internet.

Your Information:
Social Security #: - -
Please check one: Mr. Mrs. Ms.
First Name: MI: Last Name:
Joint Account Owner Information (if applicable)
First Name: Middle Initial: Last Name:
Street Address:
State: Zip:
Home Phone: Work Phone:
Mother's Maiden Name:
(Used for security verfication)
E-Mail Address
Note: All of the above information is required for approval.

Home Banking Account(s): Check if Joint Account
Account #:
Account #:
Account #:
Account #:

You desire to subscribe to the Services and authorize Us, and any third party acting on Our behalf, to serve as Your agent in processing transfers to and from targeted Accounts pursuant to Your transfer instructions, and You authorize Us to post such transfers to Your designated Account(s). You understand that We may not be able to make certain transfers if sufficient funds are not available in your designated Account(s). This authorization is in force until revoked by You or Us in writing and is subject to the Service Terms and Conditions (a current copy of which will be furnished to You) as amended from time to time.

Signature: ___________________________
Date: ____/____/________
Required when joint accounts are specified:
Signature: ___________________________
Date: ____/____/________

Application Procedure:

Please complete this application form as instructed. Sign and return it to the address listed below. Once approved, you will receive a Welcome Packet which includes instructions for use of the service and your security code.

Bethlehem 1st
Federal Credit Union

2317 Easton Ave.
Bethlehem, PA 18017-5099

Please allow seven business days for application processing.