Please complete, print and mail to:
WEOKIE CREDIT UNION
P.O. Box 26090
Oklahoma City, Ok 73126-0090 |
|
| Application For Membership |
|
|
|
| Personal Information |
|
| How Are You Eligible?
|
| Social Security Number
(SSN) or Tax I.D. (TIN):
|
| Address: Street:
|
| City:
|
| State:
|
9 Digit
Zip:
|
| Home Phone:
|
Work Phone:
|
| Member Number:
|
| Member Name- Last, First,
Middle as Listed on Social Security Card:
|
| Date of
Birth:
|
Employed
By:
|
| Spouse's
Name
|
Spouse's
Employment:
|
| Work Phone:
|
e-mail Address:
|
| Business Account: ( No
Interest/Dividends to be paid) |
| Business Name (DBA):
|
| Reference Information |
| Nearest Living Relative
Not Living With You - Name:
|
| Relationship:
|
| Address:
Street:
|
City:
|
| State:
|
9 Digit
Zip
|
| Home Phone:
|
Work Phone:
|
| Account Ownership |
| Designate the Ownership
of the Accounts and Responsibility for the Services Requested: |
|
Joint with Survivorship |
Single Party |
|
Trust |
See Account Authorization Card |
|
No Interest/Dividends |
|
|
Other:
|
| Joint Owner:
|
SSN/TIN:
|
| Address:
|
Driver's
License Number:
|
| Relationship:
|
Date of
Birth:
|
| Home
Phone:
|
Work
Phone:
|
Copy of DL attached |
Verfication performed |
| Joint Owner:
|
SSN/TIN:
|
| Address:
|
Driver's
License Number:
|
| Relationship:
|
Date of
Birth:
|
| Home Phone:
|
Work Phone:
|
Copy of DL attached |
Verfication Performed |
| Beneficiary Designation |
| Payable on Death (POD)
Account:
|
| All Accounts:
|
Designate
Specific Account(s):
|
| Beneficiary:
|
Address:
|
| Beneficiary:
|
Address:
|
UTTMA/UGMA: (as custodian
for
(minor) under the file.
Uniform Transfer/Gifts to Minors Act) |
| Minors SSN:
|
| Overdraft Protection |
| Do you want Overdraft Protection:
Yes /
No (Not available for checks presented
at window) |
| Funds to be transferred
from account number:
[transnum] |
| Under penalties of perjury,
by signing below, I certify that (1) the number shown on this form
is my correct SSN/TIN, (2) I am NOT subject to backup withholding
because I have not been notified that I am subject to backup withholding
as a result of a failure to report all interest or dividends, or the
Internal Revenue Service (IRS) has notified me that I am no longer
subject to backup withholding or I am exempt from backup witholding,
and (3) I am a U.S. citizen or U.S. resident alien.
If you have been notified by the IRS that you are subject to backup
withholding because you have failed to report all interest/dividends
on your tax return cross out item 2 above.
By signing below, I agree to the terms and conditions of the Membership
and Account Agreement, Truth-in-Savings Rate and Free Schedule, Funds
Availability Policy Disclosure and ACH, Electronic Funds Transfer
Service Agreement, and Disclosure if applicable, and to any amendment
the Credit Union makes from time to time which are incorporated herein.
I acknowledge receipt of a copy of the Agreement and Disclosures applicable
to the accounts and services requested herein.
By signing below, I hereby authorize WEOKIE Credit Union to make inquiries
into my employment and credit history.
____________________________________
Member Signature date |
____________________________________
Joint Owner Signature date |
____________________________________
Joint Owner Signature date |
____________________________________
Joint Owner Signature date |
|
