Conditions, Notications, Disclosures, and Agreements
By signing below, you agree, as Account Owners, to allow all individuals listed and signing as authorized signers, on the following page of this agreement, to conduct
business and transactions on behalf of the business or organization. You further agree that you were provided all brochures, booklets, and disclosures which
correspond to the accounts you have established under and at the time of this agreement. Additionally, you agree to abide by the conditions and requirements
contained within this agreement and within the brochures, booklets, and disclosures provided to you in conjunction with the account(s) established at the time of this
agreement. Certain terms, conditions, and restrictions associated with your membership and accounts are subject to change and could change without notice.
You understand and confirm that the accounts, and funds associated with the accounts, are not to be used in conjunction or association with any illegal activities,
which include money laundering and Internet Gambling, as defined or described within the Unlawful Internet Gambling Enforcement Act. Additionally, you understand
that, in order to help protect against terrorist financing and money laundering, Federal law requires financial institutions, such as VyStar Credit Union, to obtain,
verify, and record certain identifying information of all persons who open accounts. Therefore, VyStar Credit Union will ask for legal names, physical addresses,
dates of birth, and certain and specific other information at or around the time of establishing membership or accounts. Additionally, VyStar Credit Union, in
conjunction with verifying your identity(ies), will request to see your valid government issued identification. If VyStar Credit Union is unable to verify any required or
pertinent identifying information about the individual(s) associated with this account or the legal business or organization, VyStar Credit Union will not be able to open
the account. If any identifying information or documentation is found to be inaccurate, VyStar Credit Union may be forced to close your membership and account(s).
You attest that the funds to be deposited into the account(s) associated with this agreement, or any subsequent account opened on behalf of the business or
organization, are authorized for such deposit and that VyStar Credit Union is authorized to pay withdrawals, payments, or transfers authorized, initiated, or signed by
any of the authorized signers listed and signing below. By authorizing VyStar Credit Union to pay and honor any transaction initiated by an authorized signer, you
are relieving VyStar Credit Union from any liability in connection with the payment of withdrawals, transfers, payments, or other permitted types of transactions initiated by
any authorized signers.
If VyStar Credit Union becomes aware of a conflict or dispute amongst business owners of which the dispute or conflict involves ownership or control of funds, VyStar
Credit Union reserves the right to suspend activity on the account until documentation is provided which substantially satisfies the dispute or conflict in question.
Please note that certain minimum balances, fees, or transaction volume limitations apply to certain account types. Refer to your account opening brochures and
disclosures for additional information.
By signing your name(s) below and executing this agreement, you are agreeing to the terms, conditions, notications, and disclosures represented in
this agreement and other information represented in documentation provided to you at or in conjunction with the establishment of membership and
the opening of the associated account(s). I/We, hereby certify, to the best of my/our knowledge, that the information provided is complete and correct.
Substitute Form W-9. Certication: By signing below, under penalties of perjury, I/we certify (1) that the taxpayer identication number shown on this
form is my/our correct identication number; (2) that I/we am not subject to backup withholding either because I/we have not been notied that I/we
am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service (IRS) has notied me that
I/we am no longer subject to backup withholding; and (3) that I/we am a United States person or United States resident alien. If you have been notied
by the IRS that you are subject to backup withholding due to payee underreporting and have not been notied by the IRS that the backup withholding
is terminated, you should strike out the language in clause two of the above certication statement before you sign this application. The IRS does
not require your consent to any provision of this document other than the certications required to avoid backup withholding. (4) The FATCA code(s)
entered on this form (if any) indicating that I am exempt from FA
TCA reporting is correct. (Not Applicable)
1 - Signature of Account Owner
1 - Authorized Signer
2 - Signature of Account Owner
2 - Authorized Signer
3 - Signature of Account Owner
3 - Authorized Signer
4 - Signature of Account Owner
4 - Authorized Signer
Printed Legal Name
Printed Legal Name
Printed Legal Name
Printed Legal Name
Printed Legal Name
Printed Legal Name
Printed Legal Name
Printed Legal Name
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Note: The individual(s) listed below have been provided authorization, by the
Account Owners
on behalf of the business or organization, to
conduct and transact business on all accounts associated with this membership application, which includes payments, withdrawals, and transfers of
funds.
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
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(MM/DD/YYYY)
(MM/DD/YYYY)
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Revised 02-2018
©2018 VyStar Credit Union
–Office Use Only–
*
Member #
*Branch #
*Teller #
EIN / SSN #
* Membership Officer
*Date
