|Instructions: Sections 1, 2, and 5 must be completed. Please
review entire application and complete additional sections
as applicable. $25.00 is the minimum required to establish
membership and open your account.
1. YOUR INFORMATION
2. FIELD OF MEMBERSHIP
3. ACCOUNTS & SERVICES
4. CONSUMER LOANS
ADDITIONAL ACCOUNTS: Account Owner(s) agree that this account opening form may be used on any and all additional accounts established with the same owners unless otherwise requested.
5. AGREEMENT AND TAXPAYER ID NUMBER (TIN) CERTIFICATION & BACKUP WITHHOLDING
TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION
Under penalties of perjury, I certify that (1) the Social Security Number (SSN)/Taxpayer Identification Number (TIN) shown is my correct taxpayer identification number, (2) I am not subject to back-up withholdings because: (a) I am exempt from backup withholdings, or (b) I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest or dividends, or (c) the IRS has not notified me that I an no longer subject to backup withholding, AND (3) I am a U.S. Person (including a U.S. resident alien). INSTRUCTIONS: Cross out #2 above if the IRS has notified that you are subject to backup withholdings for failure to report all interest and dividends in your tax return.
I/we certify that I/we am/are within the field of membership, whether by way of employment, by association, or an immediate family relationship. I/We with my signature hereby agree to the Credit Union’s By-Laws, and Rules and Regulations, and any amendments thereto. If an ATM/Debit card or EFT service is requested and provided, I/We agree to the terms and acknowledge receipt of the EFT Agreement. I/We authorize the Credit Union to verify the information provided and to obtain consumer reports from consumer reporting agencies or others in connection with this account. I also agree to the terms and conditions of the Account Agreement and have received a copy of the Truth-in-Savings Agreement including Electronic Funds Transfers, Funds Availability Policy, Privacy Disclosure and Fee Schedule. The Internal Revenue Service does not require your consent to any provision of this document other than the certification to avoid backup withholding.