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Welcome to our online Membership application. Before proceeding, please provide us with the following information so we can initialize your application.

Membership Eligiblity
Member Name
Mother’s Maiden Name
Beneficiary Name
Date of Birth
Social Security Number
Home address
City
State
Zip
Home Phone (xxx-xxx-xxxx)
Business Phone (xxx-xxx-xxxx)
Email Address
Signature (Member)
Joint Member?
Joint Member Name
Signature (Joint Member)
  Yes, I wish to open a new account at REGIONAL.

Disclosures


* Eligible Lake County cities are Hammond, Highland, Hobart, Gary, East Chicago, Whiting, Griffith, New Chicago



A Member Service Advisor will contact you within 24-48 hours

Switch Kit: Easily move your automated payments and direct deposits to your new account.

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