720 Blackburn Road, Sewickley, PA  15143
Phone: (412) 749-7099 • Fax: (412) 749-7680
Secure Membership Application

How To Join:

  1. Complete the following On-Line Membership Application Request Form and submit it.
  2. Once received, we will mail you a Membership/Signature Card for your signature and your joint owner’s signature (if applicable).
  3. The signed Membership/Signature Card must be returned to the credit union along with an initial deposit of at least $26.00, $25.00 represents one (1) share and must be maintained in your Savings Account and a $1.00 membership fee.  In addition you must include a copy of a government issued photo ID of the member and joint owner 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 PA HealthCare Credit Union, and agree to conform to its bylaws and amendments thereof, and to subscribe for at least one (1) share. The PA HealthCare 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 or without the right of survivorship, as indicated by the membership/signature card 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 because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividend, or (c) the IRS 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).
All Fields Are Required
Your Email Address:
First Name: MI:
Last Name:
Social Security Number:
Street Address:  
City:
State:
Zip:
Home Phone #: 1234567890 (no separators)
Business Phone #:
Employer:

    Membership Eligibility (Check all that apply):
    Employee, independent contractor, or self employed person that works within the healthcare industry in any one of the following: Allegheny, Armstrong, Beaver, Butler, Fayette, Washington counties.  (Click here for additional details.)
    Related to Current Member

    How did you hear about us?
    Newspaper Ad -  Name:
    Employer
    Direct Mail (i.e. Postcard, Letter etc.)
    Friend/Family -  Name:
    Other: