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 who opens an 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.
Loan Purpose Amount Requested
Applicant Acct#
Birthdate
Applicant SS#
Applicant Name
ID type

ID Number

Expiration Date

Issue Date

State Of Issue
Do you own or rent?
Own Rent
Street Address

City

State Zip 		Monthly Rent/Mortgage Payment

Years at this address
Home Phone
Work Phone
Ext
Employer Name
Length of employment
Alimony child support or separate maintenance income need not be revealed if you do not choose to have it considered.
Monthly Gross Income Email Address

Co-Applicant Information
Birthdate Applicant SS#
Applicant Name
ID type

ID Number

Expiration Date

Issue Date

State Of Issue
Do you own or rent?
Own Rent
Street Address

City

State Zip 		Monthly Rent/Mortgage Payment

Years at this address
Home Phone
Work Phone
Ext
Employer Name
Length of employment
Alimony child support or separate maintenance income need not be revealed if you do not choose to have it considered.
Monthly Gross Income Email Address
You understand that when applicable, a Personal Identification Number (PIN) may be issued. This PIN, when validated will allow you, the co-applicant and any authorized users, to access your credit union's CREDIT CARD / CHECK CARD accounts through participating Automated Teller Machine (ATM) networks, subject to the terms and disclosures of the Credit Card Agreement and the Electronic Funds Transfer Disclosure for CREDIT CARD / CHECK CARD. You understand that use of your CREDIT CARD / CHECK CARD will constitute acknowledgment of receipt and agreement to the terms of the CREDIT CARD / CHECK CARD disclosures.

You also promise that everything you have stated in this application is correct to the best of your knowledge. You authorize the credit union to obtain credit reports in connection with this application for credit and for any update, renewal or extension of the credit received. If you request , the credit union will tell you the name and address of any credit bureau from which it received a credit report on you. You understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to State Chartered Credit Unions insured by NCUA.
X______________________/_____ X______________________/_____
APPLICANT'S SIGNATURE DATE OTHER SIGNATURE / DATE
By signing below, you pledge to us and grant us a security interest in share accounts with us, to secure your credit card agreement. You authorize us to apply the balance in these accounts to pay any amounts due under this agreement if you should default.
X______________________/_____ X______________________/_____
APPLICANT'S SIGNATURE DATE OTHER SIGNATURE / DATE
NCUA: Your deposits federally insured to $250,000 by the National Credit Union Administration, a US Government agency | Equal Housing Lender | America's Credit Unions: Where people are worth more than money

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