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Joint Member/Owner (Optional)
Account Designations - Payable on Death (POD)/Trust Account
Authorizations and Disclaimers
Under penalties of perjury, I certify that:
- The numbers shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued),
- 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 witholding, and
- I am a U.S. person (including a U.S. resident alien).
By submitting this application, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-In-Savings 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 a copy 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 Transers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
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