UMCU - Application

Primary Account Holder Information

Type of Membership: Individual (One name for account)	Joint (Multiple names for the account)		USA PATRIOT ACT INFORMATION 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 who opens an account.
Minor and one parent/guardian	Minor and two parents/guardians
First Name*:	Middle Name/Initial:	Last Name*:	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.
Mother's Maiden Name*:	SSN/TIN*: Not Yet Issued/No SSN Assigned	Date of Birth (MM/DD/YYYY)*: / /
ID Type:	Driver's License Number*:	Issuing State*:	Passport Country:	You may enter your State ID or Passport Number. If passport Number Select Passport as Issuing State.
ID Expiration Date (MM/DD/YYYY)*: / /	Gender:
Membership Affiliation*:	Occupation*:	Unisex Sweatshirt Size	Please choose which Affiliation applies to your Membership. Sweatshirts will be mailed within 4-6 weeks of account opening and must be open and in good standing. Sweatshirts tend to run large; please take this into consideration when selecting your sweatshirt size.
Permanent Address
Address Type:	Address Line 1*:	Address Line 2:	No P.O. Boxes Please
Zip Code*:	City*:	Country State*:
Mobile Phone Number:	Home Phone Number:		Home Phone or Mobile Phone must be given.
E-mail Address*:	Verify E-mail Address*:	The email addresses entered do not match. The email addresses entered match.
If your mailing address is different please check here.
Primary Account Holder Mailing Address
Address Type:	Address Line 1*:	Address Line 2:
Zip Code*:	City*:	Country State*:
Joint Account Holder Information
First Name*:	Middle Name/Initial:	Last Name*:
Mother's Maiden Name*:	SSN/TIN*: Not Yet Issued/No SSN Assigned	Date of Birth (MM/DD/YYYY)*:
ID Type:	Driver's License Number*:	Issuing State*:	Passport Country:	You may enter your State ID or Passport Number. If passport Number Select Passport as Issuing State.
ID Expiration Date (MM/DD/YYYY)*: / /	Gender:
I am a U.S. Person (including a U.S. Resident Alien)	Occupation*:
Joint Account Holder Permanent Address
Address Same as Primary
Address Type:	Address Line 1*:	Address Line 2:	No P.O. Boxes Please
Zip Code*:	City*:	Country State*:
Mobile Phone Number:	Home Phone Number:		Home Phone or Mobile Phone must be given.
E-mail Address*:	Verify E-mail Address*:	The email addresses entered do not match. The email addresses entered match.
If your mailing address is different please check here.
Joint Account Holder Mailing Address
Address Type:	Address Line 1*:	Address Line 2:
Zip Code*:	City*:	Country State*:
Second Joint Account Holder Information
First Name*:	Middle Name/Initial:	Last Name*:
Mother's Maiden Name*:	SSN/TIN*: Not Yet Issued/No SSN Assigned	Date of Birth (MM/DD/YYYY)*:
ID Type:	Driver's License Number*:	Issuing State*:	Passport Country:	You may enter your State ID or Passport Number. If passport Number Select Passport as Issuing State.
ID Expiration Date (MM/DD/YYYY)*: / /	Gender:
I am a U.S. Person (including a U.S. Resident Alien)	Occupation*:
Second Joint Account Holder Permanent Address
Address Same as Primary
Address Type:	Address Line 1*:	Address Line 2:	No P.O. Boxes Please
Zip Code*:	City*:	Country State*:
Mobile Phone Number:	Home Phone Number:		Home Phone or Mobile Phone must be given.
E-mail Address*:	Verify E-mail Address*:	The email addresses entered do not match. The email addresses entered match.
If your mailing address is different please check here.
Second Joint Account Holder Mailing Address
Address Type:	Address Line 1*:	Address Line 2:
Zip Code*:	City*:	Country State*:

TIN Certification & Backup Withholding Information

Under penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number.
True False
I am not subject to backup withholding because I am exempt from backup withholding due to failure to report all interest and dividends.

True False
I am a U.S. person (including a U.S. resident alien) and am exempt from FATCA reporting (U.S. citizens and resident aliens should select "True". Only select "False" if you are a non-resident alien who is exempt from U.S. tax reporting).

True False

If you checked False for item 3 above your signature does not serve to certify this section and you must complete a W-8BEN certifying your foreign status for U.S. tax reporting.

By clicking "Accept", I agree to the following:

I confirm that I have opened and reviewed the Electronic Statement Disclosure and that I consent to receiving statements, notices and other disclosures electronically.
I agree to the terms and conditions in the credit union's new member account disclosures and abide by and comply with all local, state, and federal rules and regulations.
I want UMCU to authorize and pay overdrafts on my everyday debit card and ATM transactions. I acknowledge I have the right to opt-out of this service at anytime. Opt-in Notice and Disclosure.
Click here to review our Visa Optimum Credit Card Disclosure and Agreement.
Click here to review our Visa Cash Rewards Credit Card Disclosure and Agreement.
I acknowledge that the Credit Union may obtain my consumer credit report from its designated credit reporting agency(ies) to review or collect my existing credit account(s) with the Credit Union. I further acknowledge that the information derived from my personal credit report or other information from credit reporting agencies, in addition to being used to review my existing credit accounts, may also be used to determine my eligibility for loan products and other services with the Credit Union and for communicating such eligibility to me. I understand that upon request, the Credit Union will provide me with the name(s) and address(es) of the consumer reporting agency(ies) that furnished any reports used in determining my eligibility for any or all products or services.
By signing the Membership application/signature card, you agree to be bound by the terms of the card as well as this Disclosure & Agreement as amended from time to time. You authorize us to obtain information from credit reporting agencies and financial institutions about your other checking and savings accounts and credit history. We may provide information about your account and your credit history with us to other persons, including credit reporting agencies.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.