Membership Form
1101 N IH 35, Austin TX 78702
Phone: (512) 477-2641   •  Fax: (512) 472-1324
Email: info@tccu.net


HOW TO JOIN
  1. Complete all applicable parts of this application. Sign and date it where indicated. A “member share” deposit of $25 plus a $5 membership fee will establish your credit union membership. Include deposits for any other new accounts. Deposit at least $50 to open a checking account.
  2. Once received, a member of the staff will contact you in order to complete the application and collect your opening deposit. Additional documentation will be required in order to prove your identity to include a copy of your Driver’s License.

MEMBERSHIP ELIGIBILITY (New Members check one that applies to you)
Travis County employee    Travis County resident    Work within Travis County   
I am an existing member    Family member of existing member

ACCOUNTS AND SERVICES – (Check any that apply)
New Member       Main Share (all new members are required to have a Main Share)      
Special Savings       Money Market      Holiday Club      
Advantage Checking       E-Saver Checking       Check Plus Checking      Unlimited Checking      
Share Certificate   Term   Dividend Payment (check one)  Compound   Pay by check   Credit Main Share
Debit Card (Must be 18 or older. A Checking account is required for a Debit Card.)
Overdraft Protection is available utilizing your Share (savings) account.
This service carries an additional fee each time it is used. Refer to the current Rate & Fee Schedule. Refer to your Membership and Account Agreement for other conditions. Refer to our Products & Services page online or visit a representative for additional Overdraft Protection options.

ACCOUNT OWNERSHIP – Check one
Individual – owned by one person       Joint* - joint account with survivorship      
Payable on Death (POD)* allows member (or Trustee) and if applicable Co-Trustee to designate beneficiaries. Upon the death of all members, available shares will be split equally among all surviving beneficiaries, except for IRAs with a separate beneficiary designation.
Beneficiary Names Social Security Date of Birth










* For Joint or Payable on Death memberships ONLY, the other OWNER shown (joint owner or co-trustee) is classified as Joint Owner with Survivorship. This means that on the death of a party to the account, the deceased party’s ownership in the account passes to the surviving party or parties to the account.

MEMBER/PRIMARY OWNER INFORMATION – application may be denied if all fields are not completed
First Name: MI: Physical Address :
Last Name: City : State:
Date of Birth: Zip :
Mother's Maiden Name: Mailing Address :
Social Security #: City : State:
Driver’s License # : Zip :
Driver License Issue Date : Home Phone :
Driver License Expiration Date : Cell Phone :
Driver License State of Issue : Business Phone :
Email Address : Employer:
Occupation / Title:
Are you a: (check one)
US Citizen Resident Alien Non-resident Alien, Country of Citizenship:


JOINT OWNER INFORMATION – application may be denied if all fields are not completed
First Name: MI: Physical Address :
Last Name: City : State:
Date of Birth: Zip :
Mother's Maiden Name: Mailing Address :
Social Security #: City : State:
Driver’s License # : Zip :
Driver License Issue Date : Home Phone :
Driver License Expiration Date : Cell Phone :
Driver License State of Issue : Business Phone :
Email Address : Employer:
Occupation / Title:
Are you a: (check one)
US Citizen   Resident Alien  Non-resident Alien, Country of Citizenship:

SUBMIT APPLICATION

READ THIS IMPORTANT INFORMATION BEFORE SIGNING – If you have any questions, please contact us before signing

APPLICANTS FOR MEMBERSHIP ONLY: To the Board of Directors: By signing below I hereby: (1) apply for membership; (2) submit my $25 for my one share in the credit union along with my $5 membership fee; and (3) request a Main Share account be opened to deposit my share amount. I agree that I will be the sole owner of my Main Share account even if I am applying for other accounts that may be joint.

ALL OWNERS – By signing below, I agree that all accounts, services and/or features opened or provided to me, are subject to all terms and conditions as stated in the: (1) Membership and Account Agreement (which includes Deposit Account Agreement, Funds Availability, Truth in Savings Disclosure and Electronic Funds Transfer Disclosure); (2) Rate & Fee Schedule; and (3) any other disclosure that applies to a specific product, service or feature. I acknowledge TCCU provided the aforementioned items/disclosures as applicable, and I agree and accept TCCU’s right to amend any of these items/disclosures from time to time. In addition, I request that TCCU issue a CAL PIN (personal identification number) to me for telephone access to allowable accounts and services.

PRIMARY OWNERS - By signing below, I agree that any Owner may request that additional services or features be added to any account for which the Owner is a party.

JOINT OWNERS - I agree and acknowledge that the Primary Owner, and/or any person designated in the future as the Primary Owner, of the account(s) may remove me, as a Joint Owner, from the account(s) without my authorization or knowledge and without notification. I agree to hold TCCU harmless should the Primary Owner of the account(s) remove me, as a Joint Owner, from the account(s). I further agree and acknowledge that I, as a Joint Owner, do not have the right to remove the Primary Owner from the account(s). I acknowledge that I have reviewed the Membership and Account Agreement regarding other details related to removal of a Joint Owner from the account(s).

My/Our signature(s) below is/are my/our continuing authorization for TCCU to follow my/our electronic, written or verbal instructions and I/we agree that this authorization will remain in effect unless TCCU receives written and acceptable instructions to the contrary.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT – Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. When you open an account, we may ask for your name, address, date of birth and other information that allows us to identify you. We will also ask to see and record your driver’s license and/or other identifying documents.

TAX CERTIFICATION – Under penalties or perjury, by signing below I certify that: (1) the Social Security or Tax ID Number listed in the Owner Information section, is the correct number for tax reporting purposes; (2) I am not subject to backup withholding under the provisions of the IRS Code; (3) I am a U.S. person or U.S. resident alien; and (4) all information provided is correct. Instruction to signer: If you have been notified by the IRS that you are subject to backup withholding due to a notified payee underreporting and you have not been notified that the backup withholding is terminated, you should strike out the language in clause 2 above. If you are not a U.S. person, cross our clause 3 and complete W-8BEN.

The IRS does not require your consent to any provision of this document other that certification required to avoid backup withholding.

By pressing the "Submit Application" button below, you agree to the above statement.     

Date:
 Primary Signature:
 Joint Signature:
Enter The Security Code Displayed In The Box Below:
[858932]