Fillable MEMBERSHIP APPLICATION & MASTER ACCOUNT AGREEMENT

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MEMBERSHIP APPLICATION & MASTER ACCOUNT AGREEMENT

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MEMBERSHIP APPLICATION &
MASTER ACCOUNT AGREEMENT
04/2021.CMB
__________________________
____________________
________________________
Type of Action
NEW ACCOUNT
Member Group
SYIP -
Account Number
I hereby make application for membership in Educational Federal Credit Union (Credit Union) and agree to subscribe to at least one share.
First Name
Middle Name/Initial
Last Name
SSN/ITIN
Date of Birth (mm/dd/yyyy)
Mother’s Maiden Name
Cell Phone Number
Work Phone Number
Email Address
Mailing Address
City
State
Zip Code
Physical Address (if different from mailing address)
City
State
Zip Code
I authorize the following shares and services to be opened:
SAVINGS CHECKING ATM CARD DEBIT CARD
(Checking Account required)
ONLINE BANKING
MEMBERSHIP QUALIFICATIO
N
I hereby certify that the information regarding my membership eligibility provided on this form is true and correct. I understand that my
membership is contingent upon satisfactory verification of my eligibility in accordance with the Credit Union’s Charter and of my identity in
accordance with the USA PATRIOT Act. I further understand my member account is nonassignable and nontransferable to third parties.
I am employed by
or retired from:
MDCPS MDC
UTD Other
I am a student of:
MDCPS
MDC
Other
I am a member of the PTA/PTSA:
Unit Name
I am the immediate family member of, or share a
household with, the following individual within the
Credit Union’s field of membership:
Sponsor’s Name:
Relationship to Sponsor:
Sponsor’s Eligibility:
SCHOOL / EMPLOYMENT INFORMATION
Employee ID # / Student ID#
Name of School
Employer
Occupation
By my signature below, I hereby authorize the Credit Union to establish a master member account for me and to open the shares and services I
have indicated above.
I hereby authorize the Credit Union to perform a credit check or obtain a credit report at any time. I further authorize the
Credit Union to debit $5.00 from my first deposit to activate my membership. I agree to conform to the Credit Union's bylaws, and understand and
agree that I and my account(s) with the Credit Union are subject to the separate Account Terms & Disclosures, Service Fee Schedule, and Electronic
Funds Transfer Disclosure, and any future amendments thereof, all of which are fully incorporated by reference herein.
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), (2) I am not subject to backup withholding because (i) I am exempt from backup withholding, (ii) I have not been notified by the Internal
Revenue Service (“IRS”) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (iii) after being so notified, the IRS has
notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including a U.S. resident alien). INSTRUCTIONS: If you have been notified
by the IRS that you are subject to backup withholding you must cross out item (2). The Internal Revenue Service does not require your consent to any provision of this
document other than the certifications required to avoid backup withholding.
Signature
Date Signed
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.
FOR CREDIT UNION USE ONLY
Identification Type
DL #: / State ID: / Other: Specify: ________________________________________________
Identification Number
ID Issue Date (mm/dd/yyyy)
ID Expiration Date (mm/dd/yyyy)
Proof of Address (If different from address listed on Identification)
For Non-US Persons Only: Country of Citizenship
Name of Employee verifying applicant’s Identification and/or Social Security Card
_______________________________________ Print Name: ID and SS
Branch/Department
Date
Initial Deposit Amount
_______________ $
Notes
FOR BACK OFFICE USE ONLY
TeleCheck
#: ___ ___ ___ ___
OFAC
completed by Name and Teller #:
_________________________
__________________
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MEMBERSHIP APPLICATION & MASTER ACCOUNT AGREEMENT

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Completed 12 May 2021

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