Become a Member


Date *
Date
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 when opening a new 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.
MEMBER/OWNER INFORMATION
Mailing Address *
Mailing Address
Physical Address *
Physical Address
Primary Phone Number
Primary Phone Number
Secondary Phone Number
Secondary Phone Number
ID Issuing date *
ID Issuing date
ID Expiration Date *
ID Expiration Date
Date of Birth *
Date of Birth
ACCOUNT OWNERSHIP SELECTION
Choose ONE of the following forms of account ownership by placing your initials next to the chosen form of ownership. The type of account you select may determine how property passes on your death. Your will may not control the disposition of funds held in some of the following forms of account ownership. You may choose to designate one or more convenience signers on an account, even if the account is not a convenience account. A designated convenience signer may make transactions on your behalf during your lifetime, but does not own the account during your lifetime. The designated convenience signer owns the account on your death only if the convenience signer is also designated as a P.O.D. payee or trust account beneficiary. The selection you make below will apply to all the accounts listed in the "ACCOUNT TYPE" section.
Party Initials
CONVENIENCE SIGNER DESIGNATION
Please complete this section if you have convenience signers on any of the accounts in the "ACCOUNT OWNERSHIP SELECTION" section.
JOINT MULTIPLE PARTY/AUTHORIZED SIGNER INFORMATION
Type
Mailing Address #1
Mailing Address #1
Physical Address #1
Physical Address #1
Primary Phone Number #1
Primary Phone Number #1
Secondary Phone Number #1
Secondary Phone Number #1
ID Issuing Date
ID Issuing Date
ID Expiration Date
ID Expiration Date
Date of Birth
Date of Birth
Applicant #2 Information
Type
Purpose
Primary Phone Number #2
Primary Phone Number #2
Secondary Phone Number
Secondary Phone Number
ID Issuing Date
ID Issuing Date
ID Expiration Date
ID Expiration Date
Date of Birth #2
Date of Birth #2
ACCOUNT SERVICES
In order for service to be affected, please include associated number (when applicable) and type "add" or "remove" following the number.
In order for service to be affected, please include associated number (when applicable) and type "add" or "remove" following the number.
ACCOUNT DESIGNATION
POD Beneficiaries
Upon the death of the last account owner, ownership of the account shall be divided equally among the surviving beneficiaries listed below. The beneficiaries listed below are beneficiaries to all accounts listed under the "ACCOUNT TYPE" section.
Custodial Designation Information (If Applicable)
The account(s) listed in the "ACCOUNT TYPE" section is/are held by the following
DESIGNATION OF SUCCESSOR AS CUSTODIAN (If Applicable)
Name of whom I designate
Name of successor custodian
This designation shall take effect only upon my death, resignation, incapacity or removal.
Date of Signature
Date of Signature
Date of Signature
Date of Signature
The IRS-required certifications set forth in the "TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION" section apply to the member/owner listed above.
TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION
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), 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. citizen or other U.S. person. For federal tax purposes, you are considered a U.S. person if you are: an individual who is a U.S. citizen or U.S. resident alien; a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; an estate (other than a foreign estate); or a domestic trust (as defined in Regulations Section 301.7701-7). (4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. Check the box for item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. By checking this box, this serves to strike out the language related to underreporting. Complete a W-8 BEN if you are not a U.S. person. If a W-8 BEN is completed, your signature does not serve to certify this section.
TIN Certification
AUTHORIZATION
By printing and submitting my name in the box below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Privacy Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. All of the terms, conditions, form of account ownership, account selection and other information indicated on this document applies to all of the accounts listed unless the credit union is notified in writing of a change. I/We agree that any updates identified herein amend the previously signed Member Services Request(s), and are subject to the terms and conditions of the applicable disclosures noted above. 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
Date
Date
Date
Date
Date

Please email the current ID of both yourself and all joint signers to info@redeemerfcu.org