BILL PAYMENT SYSTEM ENROLLMENT FORM (Mail to credit union after completed)  

Account Number                                                                                                                 

Name                                                                                                                                   

Address_________________________________________________________

City                                                                                                                                       

State                                                                            Zip Code                                          

Phone Number (          )                                                             

Email Address__________________________________________________________

Social Security Number                            -                       -                         

                                             (for identification purposes only)  

Signature                                                                                            Date                            

For Credit Union Use Only:  Bill Pay Eligible                                      .ENO_____

 Account Information: 

 221373710      |           dda      00        12590000 _ _ _ _ _  _  Bill Pay  Show

Retain Page 2 below for your information.  Mail top to Horizons FCU, PO Box 1881, Binghamton, NY 13902
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Text Box: BILL PAYER SYSTEM

You will receive your USER ID and your password in the mail with the return address of P.O. Box 1881, Binghamton, NY 13902-1881 .  You will need them the first time you access the Bill Payer System from your computer.  When you initially sign on, you must change your and Password (PIN).  

www.horizonsfcu.com

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