EFTA00133631 PO Box 3205 Church Street Station New York, NY 10007 (212) 693-4900 ACCOUNT SIGNATURE CARD

Account Number:	Basis for Membership: Employee of the Ci		Amends Existing Information
Please tell us about yourself	Verification Issued By: NY		Gender: Male ___ Female ___
Noel Last Name Tova First Name
Middle Initial Suffix
Date of Birth (MM/DD/YYYY) Social Security Number Mother's Maiden Name (mother's last name before marriage)
Phone Center ID (4-digits required) Home Phone Number
BRONX City NY 10456-3118 ST Zip Code
MAILING ADDRESS (where to direct mail other than the home address) If adding a PO BOX address, check here
Student Seg. Group Work #
Employer Name Job. Title Student Work #
Cell/Mobile Phone Number U.S. Person USA 1,000.00 2 Cash Deposit Amt/Month #Incoming Wires/Month Citizenship Gross Income/Month
Email Address Re-Type Email Address (for verification)
State Drivers License ID 1 Type NYS ID 1 Description ID 1 Expiration Date
School Identification ID 2 Number CUNY ID 2 Description ID 2 Expiration Date
Joint Account Holder	Verification Issued By:	Gender: Male ___ Female___
Check if address same as Primary	Amends Existing Information	Add Joint Account Holder
Last Name First Name Middle Initial Suffix
Date of Birth (MM/DD/YYYY) Social Security Number Mother's Maiden Name (mother's last name before marriage)
Phone Center ID (4-digits required) Home Phone Number
House # NS EW Street Name Street Type NS EW APT/FL APT/FL# City ST Zip Code
Employer Name Job Title Seg. Group Work # Relationship to Primary Member
Cell/Mobile Phone Number Citizenship Gross Income/Month Cash Deposit Amt/Month #Incoming Wires/Month
Email Address Re-Type Email Address (for verification)
ID 1 Type ID 1 Number ID 1 Description ID 1 Expiration Date
ID 2 Type ID 2 Number ID 2 Description ID 2 Expiration Date

EFTA00133632 PO Box 3205 Church Street Station New York, NY 10007 (212) 693-4900 ACCOUNT SIGNATURE CARD Beneficiary Information (optional) Check if address same as Primary

Last Name

First Name

Middle Initial

Suffix

Date of Birth

Social Security Number

Relationship to Primary Member

Home Phone Number

House #

NS EW

Street Name

Street Type

NS EW

APT/FL

APT/FL#

City

Zip Code

Beneficiary Information(optional) Check if address same as Primary

Last Name

First Name

Middle Initial

Suffix

Date of Birth

Social Security Number

Relationship to Primary Member

Home Phone Number

House #

NS EW

Street Name

Street Type

NS EW

APT/FL

APT/FL#

City

Zip Code

Accounts/Services To OPEN: Accounts/Services To RE-OPEN

FasTrack checking

Instant ATM/Check Card

Alternative Checking

Money Market

Touch Tone Teller

E-Statement

MCU OnLine Banking

Order Checks

Young Executive

Convert Young Executive/EasySave Account

WRG Temporary Password

Mailed ATM/Check Card

I hereby apply for membership and subscribe for at least one share ($5.00) in the Municipal Credit Union and agree to conform to its By-Laws and amendments thereof. I agree to be governed by the Account Agreement, Rules and Regulations and Schedule of Dividends, Service Charges and Fees of the Municipal Credit Union applicable to Share, FasTrack Checking, Vacation, Holiday and Money Market accounts as now in effect and as from time to time amended. I agree to be bound by the terms and conditions of the MCU Cash Connection, MCU ATM/Check Card, MCU OnLine Banking, and Touch Tone Teller Agreements (which will be later mailed/provided to me), upon my first use of such service(s). I understand that the designations made on this signature card/form will apply to all MCU deposit accounts which are or will be in the future maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), and will have the effect of revoking all previous designations made with regard to such accounts. If a joint tenant has been designated on this signature card, it is agreed that these accounts be payable to either of us and upon the death of one of us, to the survivor. Also, it is agreed that any joint tenant may, without the consent of or notice to the other, pledge all or any part of the shares in these accounts as collateral security for a loan with MCU. If a beneficiary (beneficiaries) has (or have) been designated on this signature card, it is agreed that this is a voluntary and revocable trust, and that upon my/our death, the funds in these accounts, and all other deposit accounts maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), will become the property of the named beneficiary or beneficiaries who are alive at the time of my/our death in equal proportions. If both a joint tenant and a beneficiary (or beneficiaries) have been designated on this signature card, it is agreed that the beneficiary(ies) will only acquire an interest in these accounts upon the death of the last surviving joint tenant. By signing below, I/We authorize Municipal Credit Union to perform a credit investigation including the verification of the information on this application. Verification of income and employment may also be required. Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number; and (2) that I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding. Account Holder Signature 09/23/16 Date Joint Account Holder Signature Date Yes, I elect to accept the Check Imaging option and agree to pay the associated service charge. If Joint Account Holder requests an MCU ATM/Check Card, check this box.

	Co-op City Branch
Sponsor Account Number	Branch Name