Adding Services & Joint Account Owner Application

Member Information Account # ______________________________________
I am eligible to join because: I work for (company) I am related to (name)
First Name Middle Initial Last Name Mother's Maiden Name
Street Address City State Zip Years There
Home Phone Mailing Address (if Different)
Date of Birth Social Security Number
Are you a U.S. Citizen? Yes   No Email Address
Present Employer Work Phone
Employer Address City State Zip
Hire Date Your Position Annual Salary/Wages

Joint Owner Account Or P.O.D. Information Add P.O.D.    Remove P.O.D.
Add Joint Owner Remove Joint Owner   ____Checking   ____Savings   ____VISA Check Card   ____MasterCard

First Name Middle Initial Last Name Relationship To Member
Street Address City State Zip Years There
Home Phone Mailing Address (if Different)
Date of Birth Social Security Number
Are you a U.S. Citizen? Yes   No Email Address
Present Employer Work Phone
Employer Address City State Zip
Hire Date Your Position Annual Salary/Wages
Joint on VISA Check Card?   Yes No      Joint on MasterCard?   Yes No      Joint on Checking?   Yes No
Check All Of The New Services You Need:
Note: Some services require credit approval.
Name Change
Former Name____________________

Regular Checking*
Free Checking (with Direct Deposit)
Checking Plus Interest
VISA Check Card*
STAR ATM Card
PCU Home Banking
ART Audio Response Teller
MasterCard* Gold Classic
MasterCard Credit Limit Increase
Requested Credit Limit_____________

Direct Deposit* Payroll Deduction
Additional All-Purpose Account

*Enjoy Preferred Member benefits when you have all of these services.
 
Initial Deposit Information:
I have enclosed $______________
     for Regular Checking
     for FREE Checking
     for Checking Plus Interest

 

Official Use Only
Account Number
 
 
 

Authorization: By signing below, I/we agree to the terms and conditions of the Membership and Account Application Agreement, Truth-in-Savings Rate Fee Schedule, Funds Availability Policy Disclosure, if applicable, and to any amemdment the Credit Union makes from time to time which is incorporated herein. I/We understand we have or will receive and read this Agreement and Disclosures applicable to the accounts and services requested herein, and that I/we have read and agree to all terms and conditions on this application. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Funds Transfer Agreement. The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding.

               
Applicant Signature   Date   Joint Applicant Signature   Date  
 
Pick Your PINs (Personal Identification Numbers)
ART (4-Digits)		 VISA Check Card (4-Digits)
(Or STAR ATM Card)		 All PINs are same for any Co-Applicant