Applicant Requests All Electronic Services Available,
Except Those Checked Below
I do not want to enroll in Access 365 (automated telephone access)
I do not want to enroll in Online Banking (including Bill Payment)
I do not want a VISA
R
Debit Card to access my checking account.
For your convenience and to help conserve environmental resources, your account will be
automatically set-up to receive eStatements that can be accessed anytime through Online Banking.
I do not want an ATM Card to access my savings account.
No thank you, I prefer to receive paper statements in the mail.
Checking Overdraft Protection (Complete only if Checking is selected)
INSTRUCTIONS: Indicate the account number of the account(s) you wish to debit in the event of an overdraft. (Line of credit transfers are made in $50 increments; If an overdraft
option is not selected, checks may automatically be returned). Overdrafts are to be covered by transferring funds from:
First
Overdraft
Account
Number
Second
Overdraft
Account
Number
Pay-On-Death (PLEASE PRINT)
INSTRUCTIONS: If this is a joint account, in the event of the death of one of the joint owners, the other joint owner retains full ownership of all funds in the account. If this is an
individual account, then upon the death of the individual owner, funds in the accounts covered by this application will be payable to the individuals named below. If no percentages
are shown, distribution will default to equal division. If no beneficiaries are named, funds pass at death to the estate of the last surviving owner.
%
Name (First & Last)
Address (Street, City, State, ZIP)
%
Name (First & Last) Address (Street, City, State, ZIP)
Membership Application and Agreement
By signing this application and submitting it to KeyPoint Credit Union, or by submitting this application to KeyPoint electronically:
1.
The person identified as "MEMBER," if not already a KeyPoint member, applies for membership and certifies under penalty of perjury that the membership eligibility statement is
accurately completed.
2.
I agree to abide by applicable law and KeyPoint Credit Union's bylaws in all dealings with KeyPoint Credit Union.
3. You are authorized to check my credit and account history, including verification of information on this application.
4.
This application constitutes my request for the services indicated on this application and my continuing authorization to open accounts for me under my KeyPoint membership upon
my oral or written request and deposit of funds.
5.
If a joint owner is indicated, all accounts established under this membership other than IRA will be joint ownership with right of survivorship. Joint owners are equally responsible with
members, jointly and individually, for complying with all terms of all agreements with KeyPoint Credit Union.
6. I acknowledge receipt of the KeyPoint Member Handbook, the Truth in Savings Disclosure applicable to any accounts I have opened, and Fee
Schedule and consent to their terms as amended from time to time by proper legal notice to me.
7.
I agree that if I become indebted to KeyPoint Credit Union in any way, including by use of plastic cards or by overdrawing my checking account, if I do not pay what I owe according to
my agreements, you can take any funds voluntarily deposited to KeyPoint share accounts in which I have an interest to recover all or part of what of I what I owe without notice and
without waiving other collection rights. This consent applies to all voluntarily deposited funds, including funds that may otherwise be exempt from creditors remedies, such as social
security direct deposit, unless prohibited by law or the share agreement. This consent is in addition to any right of the Credit Union to impress a lien on my shares under California
Financial Code Sec. 14856 or any equitable right of offset.
8.
Substitute W-9 Taxpayer ID Certification: You may request official IRS W-9 instructions from a KeyPoint staff member or, if applying online, click here to obtain instructions at
http://www.irs.gov/pub/irs-pdf/fw9.pdf.
I declare under penalty of perjury that (a) I am a U.S. Person (including resident alien), (b) the taxpayer ID number provided on
this application is correct and (c) either (1) I have never been notified by the IRS that I am subject to backup withholding due to failure to report dividends or
interest or (2) I have been notified by the IRS that I am no longer subject to backup withholding. The IRS does not require my consent to any term of any agreement
with the Credit Union other than the certifications required to avoid backup withholding. If I am subject to backup withholding, the following box is checked.
INSTRUCTIONS: By completing this application, I request membership in KeyPoint Credit Union. I agree to abide by the laws and bylaws in all dealings with KeyPoint Credit Union. The
information that I have stated on the application is true and complete. You are authorized to check my credit history, including verification of information on this application. I acknowledge
receipt of and agree that all of my KeyPoint Credit Union accounts will be subject to the KeyPoint Credit Union Master Disclosure/Truth-in-Savings Disclosure and Fee Disclosure as amended
from time to time. By signing below, I certify under penalty of perjury that the Taxpayer ID/Social Security number provided on this application is correct and that I am not
subject to backup withholding due to underreporting of dividends or interest. I also certify that I am a U.S. person (includes a U.S. resident alien). The IRS does not
require my consent to any provisions of the application other than the certification to avoid backup withholding.
Primary Member Signature
Date
Joint Member Signature
Date
OFFICE USE ONLY
Membership Account Number:
New Waived
Date:
/
/
Staff
Initials:
Revised Signature Card:
(check
all
that
apply)
Name
Change
Adding
Joint
Other
mm dd yy
Account Opened by (First & Last Name) / Cash Box Number
ChexSystems
Manager/Supervisor Approval (I certify that I have checked all of the above information)
Promo
Code:
(Revised 09
/12)
