| MEMBERSHIP REQUEST FORM |
When we receive your request for membership, we will send you a membership packet that will include a membership application and any pertinent credit union disclosure information. |
Membership Information |
Account # (To be completed by Credit Union) _________________________________________ |
Member |
_________________________________________ |
| Address |
State |
| _________________________________________ |
_____________ |
| City |
Zip |
| _________________________________________ |
_____________________________ |
| Home Phone |
Work Phone |
| _________________________________________ |
_____________ |
| Employment |
| _________________________________________ |
| Eligibility for Membership |
| _________________________________________ |
| SSN/TIN |
| _________________________________________ |
| Date of Birth |
Driver's Lic. # |
| _________________________________________ |
_________________________ |
| Mother's Maiden Name |
_________________________________________
| Account Type |
|
|
Share/Savings |
|
Individual Retirement Account |
|
|
Term Share/Certificate |
|
Other _________________________ |
|
Christmas Club Savings |
|
|
| |
SIGNATURE_________________________________________________ |
|
You Must Print, Sign, and Return to Credit Union
by mail (53A Jefferson Parkway, Newman GA, 30263), fax (770-253-4218), or in person
A signature is needed to complete the process.
If this page is printed and faxed to the credit union, please include a copy of a photo ID along with your request.
Before printing make sure your print margins are set to 0.2"
Look under File menu, Click on Page Setup, then change margins to 0.2"
If this page is printed and faxed to the credit union, please
include a copy of a photo I.D. along with your request. |
