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Member Application

Are you applying for a single-member or joint Membership Account?*
How did you hear about Qside Federal Credit Union?*
Membership eligibility*:
  If applicable, name of relative, or institution where you worship or study:
Promo Code:



Primary Account Holder

First Name*: MI:
Last Name*:    
Social Security Number*:    
Date of Birth*:
Home Phone*:
Work Phone:*
Day Phone:*
Email Address*:
Home Adress*:
City*:
State*: Zip*:
Employer:
Employer Address:
City:
State: Zip:



Joint Account Holder (if applicable)

First Name: MI:
Last Name:    
Social Security Number:    
Date of Birth:
Home Phone:
Work Phone:
Day Phone:
Email Address:
Home Adress:
City:
State: Zip*:
Employer:
Employer Address:
City:
State: Zip:


In Trust For/Beneficiary Designations

First Name* Last Name* MI
Address
City State Zip



Taxpayer Information

 

I certify, in accordance with the IRS W-9 instructions provided by the Credit Union and under penalty of perjury, that the social security number (SSN)/taxpayer identification number (TIN) I have provided is my/the correct identification number and that I am NOT, unless designated below, subject to backup withholding as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding.

Exempt*
I am subject to backup withholding*
I am not a United States citizen or resident (complete W-8 form)*

 

*required

We will begin processing this request immediately after receiving it. A Member Services Representative may contact you for further information in order to process your application and a form requesting your signature may be forwarded to you soon to complete the application process.

By signing below, I/we agree to the terms and conditions of the Share Account Agreement and the Truth-in-Savings Disclosures (Rate and Fee Schedule) 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. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

 

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