Thank you for choosing USE Credit Union True to our mission, USE Credit Union is focused on providing the information and tools you need to reach your financial goals – to truly be your trusted financial partner. We realize you have many banking options available to you, and we appreciate the opportunity to serve your needs. NEW MEMBER INSTRUCTIONS ONLINE INSTRUCTIONS To apply for membership online, simply visit our Website at www.usecu.org and click on the “Join Now” link. Our easy-to-use online application will walk you through the entire process, allowing you to both open and fund your new membership/accounts. MAIL INSTRUCTIONS If you would like to apply for membership by mail, this “Membership Application/Signature Card” form must be notarized (unless you’re an existing member opening an alternate membership). Please also include each of the following, along with the items listed above: ❑❑ A check or money order payable to USE Credit Union for the following items: ❍❍ Lifetime Membership Fee: $10 (or $15 for merchants or $2.50 for minors/seniors/students) ❍❍ O wnership Share Deposit: $5 (this required deposit establishes you as an owner and is returned to you once your membership is closed; only one ownership share per TIN/SSN) ❍❍ N ew Account Minimum Opening Deposit: $100 for checking and $25 for savings ($25 for Student Checking) ❑❑ A legible photocopy of one of the following forms of Primary Identification: Current Driver License, State issued ID Card, US Passport, Foreign Passport, US Military ID, Permanent Resident Card, Alien Registration Card, Matricula Consular, or SENTRI Card. ❑❑ A legible photocopy of one of the following forms of Secondary Identification: An additional item from the list of Primary IDs above or Social Security Card; Employee ID; Student ID; Welfare ID; Birth Certificate; ITIN Card or Authorization Letter from IRS; Property Tax bill; Voter Registration; Payroll Check Stub with Current Name, Address, and SSN. ❑❑ A legible photocopy of one of the following to document membership eligibility: ❍❍ For University/State employees or students: A copy of a recent pay stub or student ID card ❍❍ F or community eligibility: A copy of a utility bill, credit card bill, or other bank statement to verify address ❍❍ F or relationship to existing member: Provide the existing member’s name, address, and telephone number BRANCH INSTRUCTIONS To apply for membership in one of our branch locations, bring this completed “Membership Application/Signature Card” form, along with the original items (not photocopies) of the items listed in the “MAIL INSTRUCTIONS” section above (i.e., Primary Identification, Secondary Identification, proof of membership eligibility). PERSONAL ACCOUNTS PERSONAL ACCOUNTS MEMBERShIP APPLICATION/SIgNATURE MEMBERShIP APPLICATION/SIgNATURE CARd CARd Please complete the entire form, initial, and sign where indicated. All accounts opened will be subject to the following terms Please completeunless the entire form, initial, and sign where indicated. All accounts opened will be subject to the following terms and conditions, a subsequent Account Agreement is completed. unless a subsequent Agreement is completed. Iand am conditions, applying for membership in USE Credit Account Union. I agree to conform to its Bylaws and any amendments thereto, to purchase and retain a share in Ithe amCredit applying for to membership in USE Credit Union. I agree to and conform to its Bylaws and Union any amendments thereto,employment to purchase and and credit retaininformation a share in Union, pay a membership fee to the Credit Union, to authorize the Credit to gather whatever the Creditnecessary Union, to pay membership fee to the Credit to authorize theofCredit Unionortoloan gather whatever employment shall and credit information it deems and aappropriate. I understand that ifUnion, I fail toand remain the holder a deposit account, my membership be transferred to itinactive deemsstatus. necessary❑and appropriate. I understand that if ICard fail toUpdate remain the holder of a deposit or loan account, my membership shall be transferred to New Membership ❑ Signature inactive status. ❑ New Membership ❑ Signature Card Update I certify that I am eligible for membership through one of the following: (check only one and complete as appropriate) – N/A for existing members I certify that I am eligible for membership through one of the following: (check only one and complete as appropriate) – N/A for existing members ❑ I live / work / worship in Alameda / Sacramento / San Diego / Santa Clara / Yolo County. (circle/one) / workone) / worship in Alameda / Sacramento San Diego / Santa Clara / Yolo County. ❑ I live (circle (circleofone) (circle Employer/College/University: one) a Select Employee Group (SEG): ____________________________ Organization: _______________________ ❑ I am part I am part of a Select Employee Group (SEG): Employer/College/University: ____________________________ Organization: _______________________ ❑ ❑ I am related to the following existing member: ______________________________________ Relationship: ______________________________________ ❑ I am related to the following existing member: ______________________________________ Relationship: ______________________________________ PRIMARY MEMBER INFORMATION PRIMARY MEMBER INFORMATION Residence Type: Residence Type: ❑ ❑ Own Own ❑ ❑ Last Name Last Name Rent Rent ❑ ❑ JOINT OWNER INFORMATION JOINT OWNER INFORMATION The Credit Union will recognize the joint owner named below in the The Credit to Union will recognize joint owner named below in the transaction any activity on these the accounts. transaction to any activity these accounts. Payee on❑ Custodian (for CUTMA) ❑ Conservator ❑ Representative ❑ Representative Payee ❑ Custodian (for CUTMA) ❑ Conservator Other Other First First Middle Middle State State Zip Zip Last Name Last Name Physical Address Physical Address City City Date of Birth Date of Birth ❑ ❑ ❑ ❑ Primary Phone Primary Phone Employer Employer Cell Home Cell Work Home Work Mother’s Maiden Name Mother’s Maiden Name Alternate Phone Alternate Phone Middle Middle State State Zip Zip Physical Address Physical Address ❑ ❑ ❑ ❑ City City Cell Home Cell Work Home Work Date of Birth Date of Birth Primary Phone Primary Phone Occupation Occupation Employer Employer Verbal Password (for phone requests) Verbal Password (for phone requests) First First Social Security # Social Security # ❑ ❑ ❑ ❑ ❑ ❑ Cell Home Cell Work Home Work Mother’s Maiden Name Mother’s Maiden Name Alternate Phone Alternate Phone Cell Home Cell Work Home Work Occupation Occupation Verbal Password (for phone requests) Verbal Password (for phone requests) Email Address Email Address ❑ ❑ ❑ ❑ ❑ ❑ Social Security # Social Security # Email Address Email Address MAILING ADDRESS MAILING ADDRESS _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ Mailing Address City State Zip Mailing Address City State Zip DESIGNATION OF BENEFICIARY (Does not preclude the joint owner’s right of survivorship) DESIGNATION BENEFICIARY (Does preclude jointI/we owner’s right of Credit survivorship) In the event of myOF death, and the death of all jointnot owners of this the account, authorize USE Union to pay the balance of this/these accounts to: In the event of my death, and the death of all joint owners of this account, I/we authorize USE Credit Union to pay the balance of this/these accounts to: _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ Last Name First M.I. Address City State Zip DOB SSN# Last Name First M.I. Address City State Zip DOB SSN# _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ Last Name First M.I. Address City State Zip DOB SSN# Last Name First M.I. Address City State Zip DOB SSN# ELECTRONIC BANKING: ELECTRONIC BANKING: ❑ Online Banking ❑ Online BillPay ❑ ❑ Telephone Banking Telephone Banking Online Banking Online BillPay ❑ DIRECT DEPOSIT: ❑ DIRECT DEPOSIT: provide me information to establish Direct Deposit. ❑ Yes, please ❑ Yes, please provide me information to establish Direct Deposit. PRIMARY MEMBER’S TAX PAYER ID / SOCIAL SECURITY NUMBER: PRIMARY MEMBER’S TAX PAYER ID / SOCIAL SECURITY NUMBER: – – – – Under penalties of perjury, I/we certify that: (1) the Tax Payer ID/Social Security Numberpenalties shown on formI/we is correct not ID/Social subject toSecurity backup Under of this perjury, certify and that:(2) (1)I/we the am/are Tax Payer withholding because I/weis are exempt fromI/we backup withholding, I/we Number shown on this(a)form correct and (2) am/are not subjectorto (b) backup have not been notified(a)byI/we the Internal Revenue I/we am/are subject withholding because are exempt from Service backup that withholding, or (b) I/we to backup withholding of aRevenue failure toService report all or dividends, have not been notified as by atheresult Internal thatinterest I/we am/are subject or backup (c) the IRS has notified am/are no longer subject to backup to withholding as a me/us result that of a I/we failure to report all interest or dividends, withholding, and (3)notified I/we am/are U.S.I/we person (including a U.S. resident alien). or (c) the IRS has me/usa that am/are no longer subject to backup Complete a W-8 BEN if you are anot a U.S. person. Alternatively, by initialing at withholding, and (3) I/we am/are U.S. person (including a U.S. resident alien). the end ofa this I/we are acknowledge I/weAlternatively, am/are subject to backup Complete W-8section, BEN if you not a U.S. that person. by initialing at withholding therefore,I/we certification (2) is not the end of and, this section, acknowledge thatapplicable. I/we am/are subject to backup _______ and, therefore, _______ withholding certification (2) is not applicable. initial initial _______ _______ initial initial ESTABLISH THE FOLLOWING ACCOUNTS: (For new members only) ESTABLISH FOLLOWING ACCOUNTS: new members only) Share Account (required $5.00 held(For balance) ❑ OwnershipTHE ❑ ❑ ❑ 1. 1. 2. 2. 3. 3. Ownership Share Account (required $5.00 held balance) Plus, the accounts listed below: Plus, the accounts listed below: _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ OVERDRAFT PROTECTION: OVERDRAFT PROTECTION: Protection (available from Savings products or ❑ Yes, I want Overdraft ❑ Yes, I want Overdraft Protection (available fromyour Savings products or my Line of Credit/Credit Card). Please indicate preference below: my Line of Credit/Credit Card). Please indicate your preference below: TYPE OF ACCOUNT TYPE OF ACCOUNT 1ST CHOICE 1ST CHOICE 2ND CHOICE 2ND CHOICE CREDIT CARD: (Please select if applicable) CREDIT (Pleasein select if applicable) am interested applying for a USE Platinum Credit Card. ❑ Yes, I CARD: ❑ Yes, I am interested in applying for a USE Platinum Credit Card. TRUST ACCOUNT If establishing a trust account, complete the following: ❑ LIVING TRUST ❑ CeRTIfICaTIoN of TRUST (DepoSITS) oN fILe Trust Agreement Dated Name of Trust: ____________________________________________ Trust TIN: ________________________________________________ Name of Trustor(s): ________________________________________ I/We declare under penalty of perjury and as provided under the California Probate Code Section 18100.5 that I/we am/are qualified and have the power to act and am/are properly exercising the powers under the above named trust. Trustee Signature: _______________________________________ Co-Trustee Signature: ____________________________________ I/We have received a copy of the Account Agreement and Disclosure Statement, Electronic Services Disclosure & Statement, Member Privacy Disclosures, and current Schedule of Fees and agree with the terms and conditions for the use of these services. I/We authorize the Credit Union to check my/our ChexSystems history and my/our credit history for any reason by obtaining a credit report whenever the Credit Union has a legitimate business reason for doing so. I/We agree that the Credit Union may access the records of the California Department of Motor Vehicles from time to time to obtain my/our current mailing address and by doing so agreeing I/we am/are waiving my/our rights under section 1808.22 of the California Vehicle code. ________ ________ initial initial I/We agree to be bound by the terms and conditions of any account that I/we have in the Credit Union now or in the future. Primary Member Signature Date Joint Owner Signature Date For Living Trust Accounts: If the Trust does not name Successor Trustees, please check the box and initial here: ❑ _______ If you wish for the Successor Trustees to serve in succession rather than simultaneously, please indicate the order to serve by checking the appropriate box. Successor Trustee ❑1 ❑2 IMPORTANT: If applying for membership remotely, signature(s) must be notarized. Address City State Date of Birth Social Security # www.usecu.org Zip (866) USE-4-YOU (873-4968) ❑ OFAC Successor Trustee ❑1 ❑2 CREDIT UNION USE ONLY Opened/Updated by (Teller # / Initials) Date: Member #: SD # Address City State Date of Birth Social Security # Zip Primary Member ❑ OFAC Primary ID Type FIDUCIARY ACCOUNT ❑ FIDUCIARY (TRUSTOR): ________________________________ ❑ REPRESENTATIVE PAYEE: ______________________________ CALIFORNIA UNIFORM TRANSFER TO MINOR ACT (CUTMA) Custodian Signature Name of Minor Date of Birth Funds to remain in Trust until age: _______ PROXY STATEMENT I appoint the Board of Directors of USE Credit Union to appoint a Proxy to represent me at all meetings of the members of this Credit Union. The Proxy will vote for me on all questions and elections coming before said meeting, to give consent and in other ways to act in my place and stead. This Proxy shall remain in force for three (3) years from today, unless revoked by me in writing or revoked by subsequent Proxy. This Proxy will be withdrawn from any meeting which I attend and vote at in person. _______ Initial (Primary Member) Driver License / ________ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ U.S. Passport Foreign Passport / _________ State State-Issued ID Card / ______ State Country U.S. Military ID Permanent Resident Card Alien Registration Card Matricula Consular SENTRI Card Birth Certificates (for minors) ❑ ❑ Driver License / ________ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ U.S. Passport Foreign Passport / _________ State State-Issued ID Card / ______ State Country U.S. Military ID Permanent Resident Card Alien Registration Card Matricula Consular SENTRI Card Birth Certificates (for minors) ID# _______________ / ________ ID# _______________ / ________ ❑ Existing Member ❑ Existing Member ID Type: ID Type: Exp. Secondary ID Type Successor Custodian Name Joint Owner ❑ ❑ Exp. If different from Primary ID, address verified with: ChexSystems: No Record Initials: ChexSystems: No Record Initials: OFAC: No Record Initials: OFAC: No Record Initials: MEMBERSHIP CO-CHAIR USE ONLY: Verified by: _____________ Date: _____________ C.O.T. on file dated: Reason for update: Rev. 8/11
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