Local 41 IBEW FCU Member Application

Disclosure and Agreement to Terms

An initial $5 membership fee and $5 minimum deposit into your share account are required to open the account.

TIN Certification & Backup Withholding Information

• The number shown on this form is my correct taxpayer identification number.
• I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
• I am a U.S. person (including a U.S. resident alien).
• I authorize Local 41 IBEW FCU to verify all information provided and conduct any due diligence as required by law, including credit and background checks.
• I understand that this application is subject to final approval by LOCAL 41 IBEW FCU.
• I acknowledge receipt of Local 41 IBEW FCU's Membership Agreement.

By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein.

I/We acknowledge receipt of a copy of the Agreement and Disclosures applicable to the accounts and services requested herein. If an access card or ETF 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 certifications required to avoid backup withholding.