Membership Application¶
Primary Member/Signer¶
Last Name¶
First Name¶
Home Address (No PO Box) — Required¶
Mailing Address (if different from above)¶
Current Employer¶
Email Address¶
Joint Account Holder¶
| Last Name | First Name | MI |
| () | ||
| Current Employer | Work Phone | |
| / / | ||
| Social Security # | Date of Birth | |
| First ID Type | Second ID Type |
Designation of Beneficiary¶
(Does Not Preclude The Joint Account Holder’s Right of Survivorship)¶
In the event of my death, or the mutual death of the joint account holder(s) of this account, I/we authorize USA Federal Credit Union to pay the balance of this/these accounts to:¶
| Name of Beneficiary-Last | First | MI | |
| / / | |||
| Social Security # | Date of Birth | ||
| Address | |||
| City | Navy Federal Credit Union | Zip Code | |
□ Bronze¶
Checking - Choose One¶
Silver¶
Gold¶
EZ-Access¶
Five-Star¶
Investment Products¶
Money Market¶
Share Certificate - Term¶
IRA Share Certificate - Term¶
Other Services¶
| Debit Card¶
Receive eStatements* and avoid fees¶
*Must have Internet access¶
Loans¶
Please contact me regarding a USA Federal:¶
Auto Loan¶
Home Loan¶
Personal Line of Credit¶
Signature Loan¶
Credit Card¶
Account Number:¶
Other¶
Member Identification Requirements¶
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 or creates a new member relationship with our credit union.¶
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 document.¶
Name¶
Change¶
Certification of Taxpayer Identification Number (W-9)¶
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. person (including U.S. resident alien).¶
Certification Instructions¶
You must cross out Item 2 (above) if you have been notified by the IRS you are currently subject to backup withholding.¶
Account Agreement¶
I/We have received a copy of the All About Your Credit Union Accounts and Schedule of Fees and agree with the terms and conditions for the use of these services. All membership applications are subject to verification of information provided and eligibility prior to granting membership. We may verify your application for an account through an account verification service and reserve the right to deny any application based on the results of negative information received through that service. If we deny your application we will provide you with the name, address and telephone number of the account verification service which provided us with this information.¶
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 of Joint Account Holder¶
Date¶
For Credit Union Use Only¶
ChexSystems Verification #¶
Opened by¶
EFTA00124782¶