Dear Applicant - Tower Federal Credit Union

7901 Sandy Spring Rd. ON
Laurel, MD 20707-3589
301-497-7000 | 800-787-8328
towerfcu.org
Membership Application Please use black ink only.
ACCOUNT NUMBER ____________________________________
✓
✓
Prime Share (Savings) Overdrafts paid from this account.
Regular Checking • Home Banking/Tower Talk 24 • Debit Card Joint Owner/Convenience User Card(s)
Please list here the products or services you do not wish to receive at this time:
__________________________________________________________________________________________________________________________________________________
Other Accounts ________________________________________________________________________________________________________________________
Switch to New Account (Old Account Number ______________________________________________________________________________)
PRIMARY MEMBER
NAME________________________________________________________________________
ITIN
SSN_____________________________________ DOB______/______/______ M F
STREET ADDRESS _____________________________________________________________ CITY___________________________________ STATE__________ ZIP____________________
MAILING ADDRESS ___________________________________________________________ CITY___________________________________ STATE__________ ZIP____________________
(If different than above)
PHONE (H) ___________________________ (O) ___________________________ (C) ___________________________ E-MAIL ___________________________________________________
DRIVER’S LICENSE/GOV. ISSUED ID/U.S. MILITARY ID: STATE___________ NO. _____________________________________ ISS.______/______/______ EXP.______/______/______
(Circle one)
EMPLOYER _________________________________________________________________
PASSWORD (Required for wire transfers by phone)__________________________________
Max. 10 characters
PROOF OF ELIGIBILITY: EMPLOYER ASSOCIATION _______________________________________________________________________________________________
(Select one)
Association Name
SPONSOR _________________________________________________________________________________________________________________________
Sponsoring Member’s Name Relation to Applicant Account No.
By signing below, I, the primary member and the joint account owner, if any, agree(s) to be bound by the terms and conditions of
all agreements and disclosures applicable to my account(s) including Member Account Agreements and Disclosures
(“Agreement”), as may be amended from time to time, expressly authorize(s) Tower Federal Credit Union (“Tower”) to obtain
information about me from any source, including my employer, as more fully described in the Agreement, and acknowledge(s)
receipt of a copy of all agreements and disclosures currently applicable to my (our) account(s), including those for Truth-in-Savings.
I also authorize Tower to obtain my credit bureau report in connection with this application, and use it as well for consideration of
eligibility for other products and services from time to time.
Instructions to Primary Member: Cross out item 2 below if you have been notified by the IRS that you are currently subject to
backup withholding because you have failed to report all interest and dividends on your tax return. Cross out item 3 and complete a
W-8 BEN if you are not a U.S. person.
Under penalties of perjury, I certify that: (1) the SSN shown on this form is my correct taxpayer identification number; (2) I am
not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not 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; and (3) I am a U.S. person (including a U.S. resident alien). I
understand that the Internal Revenue Service does not require my consent to any provision of this document other than the
certifications required to avoid backup withholding.
PRIMARY MEMBER SIGNATURE
DATE
JOINT OWNER/CONVENIENCE USER SIGNATURE DATE JOINT OWNER/CONVENIENCE USER SIGNATURE DATE
JOINT OWNER/CONVENIENCE USER SIGNATURE DATE JOINT OWNER/CONVENIENCE USER SIGNATURE DATE
See reverse to complete Joint Owner, Convenience User and Payable On Death information.