Dear Applicant - Tower Federal Credit Union

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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.
Joint Owner Convenience User Payable on Death NAME ________________________________________________________________________ Joint Owner Convenience User Payable on Death NAME _______________________________________________________________________ SSN ITIN _________________________________________ DOB _____/_____/______ SSN ITIN _________________________________________ DOB _____/_____/______ ADDRESS ____________________________________________________________________ ADDRESS ___________________________________________________________________ CITY ___________________________________STATE__________ZIP____________________ CITY ___________________________________STATE__________ZIP___________________ TOWER TOWER PHONE ______________________________ ACCT. NO. ______________________________ PHONE ______________________________ ACCT. NO. _____________________________ IF JOINT OWNER/CONVENIENCE USER: E-MAIL _______________________________________________________________________ IF JOINT OWNER/CONVENIENCE USER: E-MAIL _______________________________________________________________________ DRIVER’S LICENSE/GOV. ISSUED ID/U.S. MILITARY ID: ISS.______/______/______ DRIVER’S LICENSE/GOV. ISSUED ID/U.S. MILITARY ID: ISS.______/______/______ (Circle one) (Circle one) STATE__________NO.___________________________________EXP.______/______/______ STATE__________NO.__________________________________EXP.______/______/______ IF PAYABLE ON DEATH: RELATION TO OWNER _________________________________________________________ IF PAYABLE ON DEATH: RELATION TO OWNER ________________________________________________________ Joint Owner Convenience User Payable on Death NAME ________________________________________________________________________ Joint Owner Convenience User Payable on Death NAME _______________________________________________________________________ SSN ITIN _________________________________________ DOB _____/_____/______ SSN ITIN _________________________________________ DOB _____/_____/______ ADDRESS ____________________________________________________________________ ADDRESS ___________________________________________________________________ CITY ___________________________________STATE__________ZIP____________________ CITY ___________________________________STATE__________ZIP___________________ TOWER TOWER PHONE ______________________________ ACCT. NO. ______________________________ PHONE ______________________________ ACCT. NO. _____________________________ IF JOINT OWNER/CONVENIENCE USER: E-MAIL _______________________________________________________________________ IF JOINT OWNER/CONVENIENCE USER: E-MAIL _______________________________________________________________________ DRIVER’S LICENSE/GOV. ISSUED ID/U.S. MILITARY ID: ISS.______/______/______ DRIVER’S LICENSE/GOV. ISSUED ID/U.S. MILITARY ID: ISS.______/______/______ (Circle one) (Circle one) STATE__________NO.___________________________________EXP.______/______/______ STATE__________NO.__________________________________EXP.______/______/______ IF PAYABLE ON DEATH: RELATION TO OWNER _________________________________________________________ IF PAYABLE ON DEATH: RELATION TO OWNER ________________________________________________________ Accounts with Joint Owners, Convenience Persons or Payable On Death Payees are subject to Maryland’s Multiple-Party Account Law. FOR OFFICIAL USE: Date Opened Processed By (Teller No./Initials) Checked By (Teller No./Initials) Branch No. AMO Approval Dept. Code TT24/Home Banking FM Debit Card FM ATM FM ChexSystems Approvals: MBR JT/CU JT/CU JT/CU JT/CU NOTES: 910 (11/08)
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Dear Applicant - Tower Federal Credit Union

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