Internet Banking Application - A Free Service *Primary Account-holder's Name If you are the parent or legal guardian on the above minor's account: *Address *City *State *Zip *Home Phone Cell Phone *Account Number *Choose your User ID (User ID must be a combination of alpha and numeric characters, with a minimum of 6 characters) *E-mail Address (your disclosure & PIN will be e-mailed) * Required Information I have had Internet Banking within the past 90 days. I elect to withdraw from the E-Statement program. I acknowledge the fee I will incur, which is       disclosed in Buckeye State Credit Union's Fee Schedule. For details on fee, click here Buckeye may notify you from time to time by e-mail, about product enhancements, or new services. Buckeye will never share or disclose your e-mail address to any other parties. If you don’t wish to receive these notices, you may opt-out by writing to the below listed address. I hereby consent to the electronic delivery and receipt of consumer disclosures, notices, statements, and any other documents that would ordinarily be mailed to me, via electronic instead of via paper form. I understand that I have the right to receive the aforementioned disclosures via paper if I so choose and that I may withdraw consent to receive electronic disclosures at any time. I may cancel at any time, by written notice, which must be received at the address above before the 15th of the month in which I wish to cancel. Print Application, then sign Date Primary Account-holder signature Date Legal Guardian For account-holders under 18 Mail this application to: Buckeye State Credit Union Attention: Internet Banking PO Box 848 Akron, OH 44309 Take this application to your local branch: To locate a branch, click here Fax this application to: (330) 253-9018 Branch Use Only Teller Number  Teller Initials   Date