Membership/Savings Account Application


 
Are you applying for a single-member or joint Membership Account? *
How did you hear about Qside Federal Credit Union? *
Membership Eligibility *
Primary Account Holder
Name *
Name
Home Phone *
Home Phone
Work Phone *
Work Phone
Day Phone *
Day Phone
Home Address *
Home Address
Employer Address *
Employer Address
Joint Account Holder (if applicable)
Name
Name
Home Phone
Home Phone
Work Phone
Work Phone
Day Phone
Day Phone
Home Address
Home Address
Employer Address
Employer Address
In Trust For/Beneficiary Designations
Name *
Name
Address
Address
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) *
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.Section 4