Becoming a Member

Personal Information

Name*

Title First Last

Address*

Street Address Address Line 2 City Province Postal Code

Phone Number*

Email Address*

Date of Birth*

Social Insurance Number*

Employer Name*

Employer Address*

Street Address Address Line 2 City Province Postal Code

Employer Phone Number*

Job Title*

Years with Current Employer*

Are you a Canadian Citizen?

Yes
No

Membership Information

What type(s) of account(s) are you interested in (select all that apply):*

Chequing
Savings
Investment
Loan/Line of Credit
Mortgage/MeritLine
Other

Please Specify:

What’s your main reason for opening a membership?

Deposit Income
Education Savings
Family/Household Income and Expenses
Mortgage or Loan
Pension Income
Rental Property Income
Vacation Savings
Other

Please Specify:

19. We will require your consent to access your credit bureau from TransUnion. The information being validated is protected by TransUnion and will remain confidential. Do you consent to Fountainhead Bank London accessing your credit bureau in order to open your membership?

Yes
No

Please review your information in full before submitting your application.

We love welcoming new members!

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