Please fill out the form below and print it. Either mail or fax the form to : Moonlight Credit Union 101 Deer Park Road Worthington, PA 16262 Fax Number: 724-297-3826

Full Name

Address

City

State

Zip Code

Home Phone #

E-mail Address

Your Member Account #

Last 4 Digits of ss#

Birthdate (MM/DD/YY)

Once your form has been submitted to Moonlight Credit Union via mail or fax, you will receive your new account password in the mail. This password will allow you to access the Online Banking site.

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