Member Services Request

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.

* Indicates Required.

Basic Information

Account Information

Authorization

- Service Type *
  
  New Update
  
  Service Type is Required
- Member Number
- Date*
Member/Owner Information
- Member/Owner Name*
- Mailing Address*
- Apartment/Unit
- City*
- State*
- Zip*
- Primary Phone *
  
  Phone Is: *
  
  Listed Unlisted
- Secondary Phone
  
  Phone Is:
  
  Listed Unlisted
- Email*
- SSN/TIN*
- Date of Birth *
- ID Type *
- ID Number *
- ID Issuing State*
- ID Issuing Date *
- ID Exp. Date *
- Security Code*
  Mother's maiden name
- Employer *
- Occupation/Title *
The IRS-required certifications set forth in the "TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION" section apply to the member/owner listed above.
Account Ownership Selection

Choose ONE of the following forms of account 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. The selection you make below will apply to all the accounts listed in the "ACCOUNT TYPE" section.
- Account Type
  SINGLE PARTY ACCOUNT WITHOUT PAYABLE ON DEATH (POD) DESIGNATION.
  The party to the account owns the account. On the death of the party, ownership of the account passes as a part of the party's estate under the party's will or by intestacy. The party to the account is listed as the Member/Owner.
  SINGLE PARTY ACCOUNT WITH PAYABLE ON DEATH (POD) DESIGNATION.
  The party to the account owns the account. On the death of the party, ownership of the account passes to the POD beneficiaries of the account. The account is not a part of the party's estate. POD beneficiaries are listed in the "POD BENEFICIARIES" section. The party to the account is listed as the Member/Owner.
  JOINT MULTIPLE PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP.
  The parties to the account own the account in proportion to the parties' net contributions to the account. The financial institution may pay any sum in the account to a party at any time. On the death of a party, the party's ownership of the account passes to the surviving parties. Parties to the account are listed as Member/Owner and Joint Owner.
  JOINT MULTIPLE PARTY ACCOUNT WITHOUT RIGHT OF SURVIVORSHIP.
  The parties to the account own the account in proportion to the parties' net contributions to the account. The financial institution may pay any sum in the account to a party at any time. On the death of a party, the party's ownership of the account passes as a part of the party's estate under the party's will or by intestacy. Parties to the account are listed as Member/Owner and Joint Owner.
  JOINT MULTIPLE PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP AND PAYABLE ON DEATH (POD) DESIGNATION.
  The parties to the account own the account in proportion to the parties' net contributions to the account. The financial institution may pay any sum in the account to a party at any time. On the death of the last surviving party, the ownership of the account passes to the POD beneficiaries. POD beneficiaries are listed in the "POD BENEFICIARIES" section. Parties to the account are listed as Member/Owner and Joint Owner.
  
  Account Type Selection is Required
Joint Multiple Party/Authorized Signer Information
- Authorized Signer Type *
  Joint Owner UTMA Custodian Agent Other Authorized Signer
  Authorized Signer Type is required
  Other Authorized Signer (Describe)
- Service Type *
  
  New Update Remove
- Member/Owner Name*
- Mailing Address*
- Apartment/Unit
- City*
- State*
- Zip*
- Primary Phone *
  
  Phone Is: *
  
  Listed Unlisted
- Secondary Phone
  
  Phone Is:
  
  Listed Unlisted
- Email*
- SSN/TIN*
- Date of Birth *
- ID Type *
- ID Number *
- ID Issuing State*
- ID Issuing Date *
- ID Exp. Date *
- Security Code*
- Employer *
- Occupation/Title *
- Authorized Signer Type
  Joint Owner UTMA Custodian Agent Other Authorized Signer
  Authorized Signer Type is required
  Other Authorized Signer (Describe)
- Service Type
  
  New Update Remove
- Member/Owner Name
- Mailing Address
- Apartment/Unit
- City
- State
- Zip*
- Primary Phone
  
  Phone Is:
  
  Listed Unlisted
- Secondary Phone
  
  Phone Is:
  
  Listed Unlisted
- Email
- SSN/TIN
- Date of Birth
- ID Type
- ID Number
- ID Issuing State
- ID Issuing Date
- ID Exp. Date
- Security Code
- Employer
- Occupation/Title
- Authorized Signer Type
  Joint Owner UTMA Custodian Agent Other Authorized Signer
  Authorized Signer Type is required
  Other Authorized Signer (Describe)
- Service Type
  
  New Update Remove
- Member/Owner Name
- Mailing Address
- Apartment/Unit
- City
- State
- Zip*
- Primary Phone
  
  Phone Is:
  
  Listed Unlisted
- Secondary Phone
  
  Phone Is:
  
  Listed Unlisted
- Email
- SSN/TIN
- Date of Birth
- ID Type
- ID Number
- ID Issuing State
- ID Issuing Date
- ID Exp. Date
- Security Code
- Employer
- Occupation/Title
- Account Types
  
  Share/Savings
  Share/Savings
  
  Share/Savings Status Add Remove
  
  Share Draft/Checking
  Share Draft/Checking
  
  Share Draft/Checking Status Add Remove
  
  Share Certificate/Certificate
  Share Certificate/Certificate
  
  Share Certificate/Certificate Status Add Remove
  
  Money Market
  Money Market
  
  Money Market Status Add Remove
  
  Other
  Other
  
  Other Status Add Remove
  
  Other
  Other
  
  Other Status Add Remove
- Account Types
  
  ATM Card
  ATM Card
  
  ATM Card Status Add Remove
  
  Debit Card
  Debit Card
  
  Debit Card Status Add Remove
  
  Audio Response
  Audio Response
  
  Audio Response Status Add Remove
  
  Internet Banking
  Internet Banking
  
  Internet Banking Status Add Remove
  
  Mobile Banking
  Mobile Banking
  
  Mobile Banking Status Add Remove
  
  Bill Payment
  Bill Payment
  
  Bill Payment Status Add Remove
  
  Other
  Other
  
  Other Status Add Remove
  
  Overdraft Protection
  Overdraft Protection Status Update
  
  Indicate Transfer Priority
  Priority 1
  
  Priority 2
  
  Priority 3
  
  Priority 4
Account Designations
- Beneficiary Name
- Identifying Information
- Beneficiary Name
- Identifying Information
- Beneficiary Name
- Identifying Information
Account Funding

For a new account, the minimum initial deposit for savings is $25 and checking is $25. Prior to opening the account, we must either:
1. Receive an initial deposit in person or check by mail at one of our locations
2. Receive your authorization, using our ACH form, to originate a one-time ACH transaction to fund the account.
File Upload *

For any application submitted, we must receive two forms of identification for each applicant. Primary form of ID must be a valid state or government issued photo ID. Secondary ID must include two of the following; name, picture, signature, date of birth.

Accepted formats: .pages, .doc, .docx, .pdf, .png, .jpg

Select files from your computer
or simply drag & drop them here

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. Agreeing to TIN certification is required
  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.
- Exempt Payee Code (if any)
- Exemption from FATCA reporting code (if any)
Authorization
- Before submitting this form, please read our disclosures I have read and I agree to the disclosures. Agreeing to the disclosures is required
- Member/Owner Signature *
  
  Clear Signature
- Joint Owner/Authorized Signer Signature *
  
  Clear Signature
- Joint Owner/Authorized Signer Signature
  
  Clear Signature
- Joint Owner/Authorized Signer Signature
  
  Clear Signature

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Important Information About Procedures for Opening a New Account

Member/Owner Information

Account Ownership Selection

Joint Multiple Party/Authorized Signer Information

Account Types

Account Types

Account Designations

Account Funding

File Upload *

TIN Certification and Backup Withholding Information

Authorization