EFTA00124590.pdf

Inc murnciPAI CREDIT UNION Ul PO Box 3205 Church Street Station .. New York, NY 10007 (212) 6934900 ACCOUNT SIGNATURE CARD Account Number: Please tell us about yourself Basis for Membership: Employee of the CI Amends Existing Information X Verification Issued By: NY I Last IIa First Name Date of Birth (MAYDDNYYY) Gender: x Male i& Female Mother's Maiden Name (mothers last name before manage) (4-digits required) Middle Initial Suffix Phone Center ID BROOKLYN Home Phone Number NY 11207-1012 House # NS Street Name Street NS APT/ APT! City ST Zip Code EW Type EW FL FL# MAILING ADDRESS (where to direct mai other than the home address) If adding a PO BOX address, check here House # NS Street Name Street NS APT/ APT! City ST Zip Code EW Type EW BOX BOX# NYC DHS Employer Name &feeler Job. Title U.S. Person USA NYC Agency Seg. Group 3,500.00 20 718463-4702 Work # 0 Cell/Motile Phone Number Citizenship Gross IncomelMonth Cash Deposit Amt/Month #Incoming Wires/Month E NYS Learners Permit NY Permit ID 1 Type um er ID 1 Description Job Identification 504 NYC DHS ID 2 Type ID 2 Number ID 2 Description ID 2 Expiration Date 03/26/19 ID 1 Expiration Date 06/30/20 Joint Account Holder Check if address same as Primary Verification Issued By: I Amends Existing Information Gender: Male Female Add Joint Account Holder Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Mother's Maiden Name Phone Center ID Home Phone Number (MAVDOMYYY) (mothers last name before manage) (4-digits required) House # NS Street Name Street NS APT! APT! City ST Zip Code EW Type EW FL FL# Employer Name Job Title Seg. Group Work # Relationship to Primary Member Cell/Motile Phone Number Citizenship Gross Income/Month Cash Deposit Amt/Monti ffincoming WireslMonth Email Address Re-Type Email Address (for verification) ID 1 Type ID 1 Number ID 1 Description ID 1 Expiration Date ID 2 Type ID 2 Number ID 2 Description ID 2 Expiration Date EFTA00124590 MC MUNICIPAL CREDIT UNION U U PO Box 3205 Church Street Station New York, NY 10007 (212) 693.4900 ACCOUNT SIGNATURE CARD Beneficiary Information (optional) x Check if address same as Primary Last Name Sod First Name Middle Initial Relationship to Primary Member Ho House # NS Street Name Street NS APT/ APT! EW Type EW FL FL# Beneficiary Information (optional) Check if address same as Primary Last Name First Name Date of Birth Social Security Number House # NS EW X Shales Money Market Suffix BROOKLYN NY 11207 City ST Zip Code Middle Initial Suffix Relationship to Primary Member Home Phone Number Street Name Street NS Type EW X Accounts/Services To OPEN: X FasTrack checking X Touch Tone Teller APV FL APT! City ST Zip Code FL# Accounts/Services To RE-OPEN X Instant ATM/Check Card Alternative Checking E-Statement x MCU OnLine Banking Young Executive Convert Young Executive/EasySave Account WRG Temporary Password X Order Checks Mailed ATM/Check Card I hereby apply for membership and subscribe for at least one share (55.00) in the Municipal Credit Union and agree to conform to its Bylaws and amendments thereof. I agree to be governed by the Account Agreement, Rules and Regulations and Schedule of Dividends. Service Charges and Fees of the Municipal Credit Union applicable to Share. FasTrack Checking. Vacation. Holiday and Money Market accounts as now in effect and as from time to time amended. I agree to be bound by the terms and conditions of the MCU Cash Connection, MCU ATM/Check Card. MCU OnLine Banking. and Touch Tone Teller Agreements (which will be later mailecVprovided to me), upon my first use of such service(s). I understand that the designations made on this signature card/form will apply to all MCU deposit accounts which are or will be in the future maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), and will have the effect of revoking all previous designations made with regard to such accounts. If a joint tenant has been designated on this signature card, it is agreed that these accounts be payable to either of us and upon the death of one of us. to the survivor. Also, it is agreed that any joint tenant may. without the consent of or notice to the other, pledge all or any pan of the shares in these accounts as collateral security for a loan with MCU. If a beneficiary (beneficiaries) has (or have) been designated on this signature card. it is agreed that this is a voluntary and revocable trust, and that upon my/our death, the funds in these accounts, and all other deposit accounts maintained under the same root account number (except IRA. Youth Club, and Share Certificate accounts). will become the properly of the named beneficiary or beneficiaries who are alive at the time of my/our death in equal proportions. If both a joint tenant and a beneficiary (or beneficiaries) have been designated on this signature card, it is agreed that the beneficiary/(ies) will only acquire an interest in these accounts upon the death of the last surviving joint tenant. By signing below. ViNe authorize Municipal Credit Union to perform a credit investigation including the verification of the information on this application. Verification of income and employment may also be required. Under penalties of perjury, I certify (1) that the number shown on this form Is my correct taxpayer identification number; and (2) that I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding. Accou tld&r•Signa 0915+16 Date Joint Account Holder Signature Date Yes, I elect to accept the Check Imaging option and agree to pay the associated service charge. If Joint Account Holder requests an MCU ATM1Check Card, check this box. Brooklyn Branch AUSON JOHN WILLIAMS Sponsor Account Number Branch Name Member Service Representative EFTA00124591