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First Name

Middle Initial

Last Name

Suffix

Email Address ( Your email address will be your login )

Date Of Birth

Street Address

Unit or Apt

City

State

Zip

Mobile Phone Number

Consent to Verify Identity.
To complete the application process, we will need to verify your identity using a One-Time-Passcode ("OTP"), and we need your consent to use the mobile phone number provided on your application to receive the passcode. Please note that the mobile phone number provided to verify your identity, will include disclosing the phone provided to a third party in order to send you an OTP via SMS text message. When the OTP is sent, mobile messaging rates may apply. This mobile phone number will only be used for verification and account security purposes.

You are providing your consent by checking the following box and clicking "Continue."

I wish to continue my MEFA application. I authorize you to use the mobile phone number I provided on my application to verify my identity as described above.

Password

Confirm Password

I have read, understood, and consent to the language and authorizations outlined in MEFA Electronic Communication and Signature, and MEFA's Privacy Policy. We recommend that you retain a copy for your reference.