Town of Palm Beach Federal Credit Union

Membership Application


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 who opens an 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 driverís license or other identifying documents.

Confidentiality of this information will be maintained as required under the Privacy Act and all other applicable laws and regulations.

Membership Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

The items marked with (*) are required fields.


General Information
Will there be a co-applicant on this application?



(If Yes, the co-applicant section has the same required fields as the primary applicant.)
Membership Eligibility
*I am eligible for membership through:



Primary Applicant
 
I certify that:
The TIN is correct and
I /
 
 
 
Home Address (not P.O. Box)
Time at Current Residence
Residence Type
 
Mailing Address (if different)
 
Employment History
Employer's Address

Co-Applicant 1 (if applicable)
 
 
 
Home Address (not P.O. Box)
Time at Current Residence
Residence Type
 
Mailing Address (if different)
 
Employment History
Employer's Address

Co-Applicant 2 (if applicable)
 
 
 
Residence Address (not P.O. Box)
Time at Current Residence
Residence Type
 
Mailing Address (if different)
 
Employment History
Employer's Address

References
Nearest relative Not Living With You

Additional Information
How would you prefer to be contacted?






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

 


 

Copyright © 2013 Town of Palm Beach Federal Credit Union. All Rights Reserved

  Your deposits Federally Insured
Town of Palm Beach Federal Credit Union is federally insured by the National Credit Union Administration

Unauthorized Access is Prohibited. All Accesses are Monitored.