MASTER MEMBERSHIP
APPLICATION/SIGNATURE CARD
1440 Rosecrans Avenue, Manhattan Beach, CA 90266
800.854.9846 | Kinecta.org
KFCUR25027-06/20Page 2 of 2
FOR OFFICE USE ONLY
REP # OFFICE # DATE
Membership #
SECTION 2
MEMBERSHIP ELIGIBILITY
I AM ELIGIBLE TO JOIN KINECTA IN ONE OF THE FOLLOWING WAYS:
A $5.00 minimum savings account deposit is required for each member.
£ Employee of a Select Employer Group (SEG): Company name
£ Community Group (CG): £ Live £ Work £ Worship £ Attends School £ Anaheim £ Lancaster £ Rialto £ Santa Ana £ Check ZIP (Requires ZIP Code)
£ Associational Group (AG): Associational Common Bond (Locals, PTAs, Churches, etc.)
£ Immediate family or household member: Member Name Relationship
£ Innovision Society (Must Include Innovision Society Membership Application). Co-Op #
SECTION 3
CONSENT TO CONTACT BY TELEPHONE AND/OR BY TEXT
Consent to Contact by Telephone and/or by Text: By signing this document below, I/we (primary account holder, and any joint owners referenced herein) agree that the Credit Union may from time to time make
calls and/or send text messages to me/us at any telephone number(s) provided in this master membership application, including any mobile/cellular telephone numbers and/or numbers that are later converted to
mobile/cellular telephone numbers, that may or may not result in data usage and/or charges to me/us. This is so the Credit Union can service and keep me informed about my membership, any and all of my/our
account(s), any loans and transactions I/we have executed or may enter into with Kinecta, and/or to provide me/us with fraud, security breach, or identity theft alerts. I/We also agree that I/we may be contacted
by the Credit Union service providers and/or any third party making such calls or sending such text messages on its behalf. The manner in which these calls or text messages may be made to me/us include, but
are not limited to, the use of prerecorded/artificial voice messages and automatic telephone dialing systems. I/We understand that I/we am/are not required to provide consent as a condition to receiving the
Credit Union’s products or services. I/We may change the telephone number(s) provided at any time by contacting the Credit Union at 1-800-854-9846.
By also initialing this paragraph below, I/we further authorize Kinecta to contact me/us as set forth above, by making calls and/or sending text messages to me/us at any telephone number(s) I/we have
provided in this master membership application, through, but not limited to, the use of prerecorded/artificial voice messages and automatic telephone dialing systems, to offer products and services that
might be of interest to me/us. I/We understand that I/we am/are not required to provide this additional consent as a condition to receiving the Credit Union’s products or services.
Primary Initials ______ Joint Initials ______ Joint Initials ______
SECTION 4
PART 1 Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name”
line to avoid backup withholding. For individuals, this is your social security number (SSN). For other
entities, it is your employer identification number (EIN).
TAX IDENTIFICATION NUMBER EMPLOYER IDENTIFICATION NUMBER
PART 2 Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from
backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person. The FATCA code certification does not apply. Certification instructions. You must cross out item 2
above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item
2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other
than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. The Internal Revenue Service does not require your consent to any provision of this document
other than the certifications required to avoid backup withholding.
SIGN
HERE
SIGNATURE OF
U.S. PERSON
DATE
£
CHECK BOX IF NON-RESIDENT ALIEN AND DO NOT SIGN THE SIGNATURE LINE ABOVE. MUST COMPLETE A W-8BEN INSTEAD.
SECTION 5
CONSENT TO PULL CREDIT REPORT
I/We request and authorize the Credit Union to obtain my/our consumer credit report from the Credit Union’s designated credit reporting agency(ies), now and/or in the future, for the express purpose of
determining my/our eligibility for the Credit Union’s products and/or services, which may result in the Credit Union offering me/us products and/or services, marketing to me/us, or inviting me/us to apply
for products or services. I/We understand that upon request, the Credit Union will provide me/us with the name(s) and address(es) of the consumer reporting agency(ies) that furnished any reports used in
determining my/our eligibility for any or all products or services. I/We acknowledge that certain credit scoring algorithms may take into account whether institutions check my credit; the Credit Union will
attempt to determine eligibility for products and services in a manner that does not impact my/our credit score, but the Credit Union cannot guarantee a particular outcome. I/We may withdraw this consent
to obtain and use my/our credit report at any time by providing notice to the Credit Union in writing at 1440 Rosecrans Ave., Manhattan Beach, CA 90266, or by phone at 800.854.9846.
Primary Initials ______ Joint Initials ______
SECTION 6
ACCOUNT AGREEMENT
This membership application controls all accounts opened and listed in the account number section at the top of this form except Business Accounts. Individual Retirement Accounts (IRA) require an additional
agreement to be executed. I/We understand that if I/we wish to open new accounts under terms and conditions other than those set forth herein, or with different ownership, I/we must execute a new Master
Membership Application/Signature Card (“agreement”). I/We also understand that the terms and conditions set forth in any subsequently-executed agreement shall apply only to those account numbers listed in
the new agreement.
I/We authorize the credit union to obtain consumer credit reports for the purpose of evaluating this application and in the future for other legitimate purposes associated with my/our account(s), including but not
limited to, account review and servicing and collections purposes. Upon my/our request, you will provide me/us with the name(s) and address(es) of the consumer reporting agency(ies) that furnished the report(s).
I/We agree to conform to the Credit Union by-laws, the terms and conditions of the Membership Application/Signature Card and Agreements & Disclosures (Share Accounts, Truth in Savings, Electronic Services
and Privacy Policy). I/We hereby apply for membership and I/We authorize Kinecta Federal Credit Union to verify all the information supplied herein; and to verify my/our creditworthiness.
PRIMARY MEMBER SIGNATURE: DATE:
JOINT MEMBER SIGNATURE: DATE:
JOINT MEMBER SIGNATURE: DATE:
