EFTA00124782.pdf

Membership Application Account Number: Checking - Choose One Certification of Taxpayer identification Number (W-9) Under penalties of perjury. I certify that: u Bronze (1) The number shown on this form is my correct taxpayer O Silver identification number (or I am waiting for a number to be issued to me) and ome Address (No PO Box) -*squired Gold H4 ibfre.-.e... c r))r. Oct3 EZAccess (2) I am not subject to backup withholding because (a) t am exempt from backup withholding, or (b) I have not been noutied by the Internal Revenue Service (IRS) That I em CI State Zi Code E FiveStar subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified ailing Address ( f-different from above) me that I am no longer subject to backup withholding, Investment Products and rArnin . Yr". 1 Money Market (3) I am a U.S. person (including U.S. resident alien). pity State Zip Code Certification instructions kepi> Cot Ornri-- • Share Certificate - Term You must cross out Item 2 (above) If you have been notified Current Employer IRA Share Certificate - Term by the IRS you are currently subject to backup withholding. Account Agreement Other Services I/We have received a copy of the All About Your Credit Union Accounts and Schedule of Fees and agree with the terms Debit Card and conditions for the use of these services. All membership applications are subject to verification of information provided .! Receive eStatements* and avoid fees and eligibility prior to granting membership. We may verify saarst race hitrenet access your application for an account through an account verification service and reserve the right to deny any application based Email Address on the results of negative information received through that Loans service. If we deny your application we will provide you with Joint Account Holder the name, address and telephone number of the account Please contact me regarding a USA Federal: verification service which provided us with this information. Last Name First Name MI Auto Loan Home Loan —I Signature Loan The Internal Revenue Service does not require your Personal Line of Credit centerline any provision of this document other than the 'Credit Card Current Employer Work Phone Other / / Social Security # Date of Birth First ID Type Second II) Type Signature of Joint Account Holder Date Designation of Beneficiary Member identification Requirements (Does Not Preclude The Joint Account Hordes Ret of Surthorship) in the event of my dibMit, of the mutual death of tke pint Aucksk hukfunsi of this account, I/we authorize USA Federal Credit Union to pay the balance of thls/these accounts to: 1 To help the ipernment fel the fUrxliflp. Of terOriSM ard money burxtertne activities. Fedora: low requires all franca/ inshmtions to obtain, verify and retold information that identities, oath person who opens an account ce For Credit Union Use Only creates a new molter metionstiip wtth cur credit union. Name of Beneficiary-Lev First MI what this means for wu: When you open an scowl. we will ask for your nine. esti. date of birth, and other Information dun will aloes us to ChaxSystems Verification / / Social Security a Date eh 01nit irlentity may *so ask to see tffr r rivers license or other identshzing 4.0eurnen Openedby Addle** klernbersboOrtIcer SEG City Navy Federdineadit Union Zea Code WV I. EFTA00124782