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Member Account Agreement-CA
Bankers Systems Custom MDF. ECAMPM11
Wolters Kluwer Financial Services 2004, 2008
Member Account Agreement
Member No.
Page 1 of 2Initials:
*
Enter Non-Individual Owner Information on page 2. There is additional
Owner/Signer Information space on page 2.
The undersigned authorize the credit union to investigate credit and employment history and
obtain reports from consumer reporting agency(ies) on them as individuals. Except as
otherwise provided by law or other documents, each of the undersigned is authorized to
make withdrawals from the account(s), provided the required number of signatures indicated
above is satisfied. The undersigned agree to the by-laws of the credit union, including any
requirement to pay a membership or entrance fee, and agree to the terms of, and
acknowledge receipt of copy(ies) of, this document and the following:
IMPORTANT ACCOUNT OPENING INFORMATION: Federal law requires
us to obtain sufficient information to verify your identity. You may be
asked several questions and to provide one or more forms of
identification to fulfill this requirement. In some instances we may use
outside sources to confirm the information. The information you provide
is protected by our privacy policy and federal law.
(Check appropriate beneficiary designation above.)
l Truth in Savings
Account Title & Address
Name
Birth Date
Occupation
Employer
Mailing Address
(if different)
Mother's Maiden Name
SSN/TIN
Home Phone
Work Phone
Mobile Phone
E-Mail
Signature(s)Owner/Signer Information 2
The specified ownership will remain the same for all accounts.
l Individual l Representative Payee
l Joint Account l Estate
l CUTMA l Guardianship
l Conservatorship
l Trust-Separate Agreement Dated:
l
Beneficiary Designation
Beneficiary Name(s), Address(es), and SSN(s)
(Check appropriate ownership above.)
Owner/Signer Information 1
MPMPLZCU-CA 3/15/2015
Ownership of Account
l Totten Trust l Pay-on-Death (P.O.D.)
l
Address
Other ID
(Description, Details)
Gov't Issued Photo ID,
Type, Number, State,
Issue Date, Exp. Date
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X
X
X
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l Dividend Rate Sheet
l What You Need To Know About Overdrafts and Overdraft Fees
l
l Consumer Master Disclosure
l General Fee Disclosure
l Courtesy Pay Privilege Agreement
Date
Date
Date
Date
Name
Birth Date
Occupation
Employer
Mailing Address
(if different)
Mother's Maiden Name
SSN/TIN
Home Phone
Work Phone
Mobile Phone
E-Mail
Address
Other ID
(Description, Details)
Gov't Issued Photo ID,
Type, Number, State,
Issue Date, Exp. Date
l Electronic Disclosure
l Privacy
SSN%
Beneficiary Address
Beneficiary Name
SSN%
Beneficiary Address
Beneficiary Name
SSN%
Beneficiary Address
Beneficiary Name
SSN%
Beneficiary Address
Beneficiary Name
The Internal Revenue Service does not require your consent to any provision of
this document other than the certifications required to avoid backup withholding.
Date:
