Membership Application

USA PATRIOT ACT

Important Information About Procedures For Opening A New Account

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you:
When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

MEMBERSHIP APPLICATION

Membership Eligibility:
Primary Account Holder (Member)
Full Name:
Name of Joint Account Owner, if any: (see below)
Street Address:
Mailing Address:
City:
State: ZIP: County:
Years at this Address:
E-mail Address:
Home telephone number :
Work telephone number:
Social Security Number:
Taxpayer ID Number (if different from Social Security Number):
Date of birth ( -- / -- / -- ):
Employer's Name:
Street Address:
Mailing Address:
City:
State: ZIP: County:
Other instructions or needs you may have: If this is an individual account, you may send it now. If this is a joint account, please complete the following section as well. Thank you!
Full Name of Joint Account Owner:
Street Address:
Mailing Address:
City:
State: ZIP: County:
Years at this Address:
E-mail Address:
Home Telephone Number:
Work Telephone Number:
Social Security Number:
Taxpayer ID Number (if different from Social Security Number):
Date of birth ( -- / -- / -- ):
Employer's Name:
Street Address:
Mailing Address:
City:
State: ZIP: County:
All disclosure information will be delivered upon approval of membership. Member approval will be granted according to the credit union's policies and procedures.

This credit union is federally insured by the National Credit Union Administration.
We Do Business in Accordance with the Federal Fair Housing Law and the Equal Credit Opportunity Act.