Thank you for choosing USE Credit Union

Thank you for choosing USE Credit Union
True to our mission, USE Credit Union is focused on providing the information and tools
you need to reach your financial goals – to truly be your trusted financial partner. We realize you have many
banking options available to you, and we appreciate the opportunity to serve your needs.
NEW MEMBER INSTRUCTIONS
ONLINE INSTRUCTIONS
To apply for membership online, simply visit our Website at www.usecu.org and click on the “Join Now”
link. Our easy-to-use online application will walk you through the entire process, allowing you to both open
and fund your new membership/accounts.
MAIL INSTRUCTIONS
If you would like to apply for membership by mail, this “Membership Application/Signature Card” form
must be notarized (unless you’re an existing member opening an alternate membership). Please also
include each of the following, along with the items listed above:
❑❑ A check or money order payable to USE Credit Union for the following items:
❍❍ Lifetime Membership Fee: $10 (or $15 for merchants or $2.50 for minors/seniors/students)
❍❍ O
wnership Share Deposit: $5 (this required deposit establishes you as an owner and is
returned to you once your membership is closed; only one ownership share per TIN/SSN)
❍❍ N
ew Account Minimum Opening Deposit: $100 for checking and $25 for savings ($25 for
Student Checking)
❑❑ A legible photocopy of one of the following forms of Primary Identification: Current Driver License,
State issued ID Card, US Passport, Foreign Passport, US Military ID, Permanent Resident Card,
Alien Registration Card, Matricula Consular, or SENTRI Card.
❑❑ A legible photocopy of one of the following forms of Secondary Identification: An additional item from the
list of Primary IDs above or Social Security Card; Employee ID; Student ID; Welfare ID; Birth Certificate;
ITIN Card or Authorization Letter from IRS; Property Tax bill; Voter Registration; Payroll Check Stub with
Current Name, Address, and SSN.
❑❑ A legible photocopy of one of the following to document membership eligibility:
❍❍ For University/State employees or students: A copy of a recent pay stub or student ID card
❍❍ F
or community eligibility: A copy of a utility bill, credit card bill, or other bank statement to
verify address
❍❍ F
or relationship to existing member: Provide the existing member’s name, address, and
telephone number
BRANCH INSTRUCTIONS
To apply for membership in one of our branch locations, bring this completed “Membership Application/Signature
Card” form, along with the original items (not photocopies) of the items listed in the “MAIL INSTRUCTIONS”
section above (i.e., Primary Identification, Secondary Identification, proof of membership eligibility).
PERSONAL
ACCOUNTS
PERSONAL
ACCOUNTS
MEMBERShIP
APPLICATION/SIgNATURE
MEMBERShIP APPLICATION/SIgNATURE CARd
CARd
Please complete the entire form, initial, and sign where indicated. All accounts opened will be subject to the following terms
Please
completeunless
the entire
form, initial,
and sign
where indicated.
All accounts opened will be subject to the following terms
and conditions,
a subsequent
Account
Agreement
is completed.
unless a subsequent
Agreement
is completed.
Iand
am conditions,
applying for membership
in USE Credit Account
Union. I agree
to conform
to its Bylaws and any amendments thereto, to purchase and retain a share in
Ithe
amCredit
applying
for to
membership
in USE Credit
Union.
I agree
to and
conform
to its Bylaws
and Union
any amendments
thereto,employment
to purchase and
and credit
retaininformation
a share in
Union,
pay a membership
fee to the
Credit
Union,
to authorize
the Credit
to gather whatever
the
Creditnecessary
Union, to pay
membership
fee to the Credit
to authorize
theofCredit
Unionortoloan
gather
whatever
employment shall
and credit
information
it deems
and aappropriate.
I understand
that ifUnion,
I fail toand
remain
the holder
a deposit
account,
my membership
be transferred
to
itinactive
deemsstatus.
necessary❑and
appropriate.
I understand
that if ICard
fail toUpdate
remain the holder of a deposit or loan account, my membership shall be transferred to
New
Membership
❑ Signature
inactive status.
❑ New Membership ❑ Signature Card Update
I certify that I am eligible for membership through one of the following: (check only one and complete as appropriate) – N/A for existing members
I certify that I am eligible for membership through one of the following: (check only one and complete as appropriate) – N/A for existing members
❑ I live / work / worship in Alameda / Sacramento / San Diego / Santa Clara / Yolo County.
(circle/one)
/ workone)
/ worship in Alameda / Sacramento
San Diego / Santa Clara / Yolo County.
❑ I live (circle
(circleofone)
(circle Employer/College/University:
one)
a Select Employee Group (SEG):
____________________________ Organization: _______________________
❑ I am part
I am part of a Select Employee Group (SEG): Employer/College/University: ____________________________ Organization: _______________________
❑
❑ I am related to the following existing member: ______________________________________ Relationship: ______________________________________
❑ I am related to the following existing member: ______________________________________ Relationship: ______________________________________
PRIMARY MEMBER INFORMATION
PRIMARY MEMBER INFORMATION
Residence Type:
Residence Type:
❑
❑
Own
Own
❑
❑
Last Name
Last Name
Rent
Rent
❑
❑
JOINT OWNER INFORMATION
JOINT OWNER INFORMATION
The Credit Union will recognize the joint owner named below in the
The
Credit to
Union
will recognize
joint owner named below in the
transaction
any activity
on these the
accounts.
transaction
to any activity
these
accounts.
Payee on❑
Custodian
(for CUTMA) ❑ Conservator
❑ Representative
❑ Representative Payee ❑ Custodian (for CUTMA) ❑ Conservator
Other
Other
First
First
Middle
Middle
State
State
Zip
Zip
Last Name
Last Name
Physical Address
Physical Address
City
City
Date of Birth
Date of Birth
❑
❑
❑
❑
Primary Phone
Primary Phone
Employer
Employer
Cell
Home
Cell
Work
Home
Work
Mother’s Maiden Name
Mother’s Maiden Name
Alternate Phone
Alternate Phone
Middle
Middle
State
State
Zip
Zip
Physical Address
Physical Address
❑
❑
❑
❑
City
City
Cell
Home
Cell
Work
Home
Work
Date of Birth
Date of Birth
Primary Phone
Primary Phone
Occupation
Occupation
Employer
Employer
Verbal Password (for phone requests)
Verbal Password (for phone requests)
First
First
Social Security #
Social Security #
❑
❑
❑
❑
❑
❑
Cell
Home
Cell
Work
Home
Work
Mother’s Maiden Name
Mother’s Maiden Name
Alternate Phone
Alternate Phone
Cell
Home
Cell
Work
Home
Work
Occupation
Occupation
Verbal Password (for phone requests)
Verbal Password (for phone requests)
Email Address
Email Address
❑
❑
❑
❑
❑
❑
Social Security #
Social Security #
Email Address
Email Address
MAILING ADDRESS
MAILING ADDRESS
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Mailing Address
City
State
Zip
Mailing Address
City
State
Zip
DESIGNATION OF BENEFICIARY (Does not preclude the joint owner’s right of survivorship)
DESIGNATION
BENEFICIARY
(Does
preclude
jointI/we
owner’s
right
of Credit
survivorship)
In the event of myOF
death,
and the death of
all jointnot
owners
of this the
account,
authorize
USE
Union to pay the balance of this/these accounts to:
In the event of my death, and the death of all joint owners of this account, I/we authorize USE Credit Union to pay the balance of this/these accounts to:
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Last Name
First
M.I.
Address
City
State
Zip
DOB
SSN#
Last Name
First
M.I.
Address
City
State
Zip
DOB
SSN#
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Last Name
First
M.I.
Address
City
State
Zip
DOB
SSN#
Last Name
First
M.I.
Address
City
State
Zip
DOB
SSN#
ELECTRONIC BANKING:
ELECTRONIC
BANKING:
❑ Online Banking
❑ Online BillPay
❑
❑
Telephone Banking
Telephone Banking
Online Banking
Online BillPay
❑
DIRECT DEPOSIT: ❑
DIRECT
DEPOSIT:
provide me information to establish Direct Deposit.
❑ Yes, please
❑ Yes, please provide me information to establish Direct Deposit.
PRIMARY MEMBER’S TAX PAYER ID / SOCIAL SECURITY NUMBER:
PRIMARY MEMBER’S TAX PAYER ID / SOCIAL SECURITY NUMBER:
–
–
–
–
Under penalties of perjury, I/we certify that: (1) the Tax Payer ID/Social Security
Numberpenalties
shown on
formI/we
is correct
not ID/Social
subject toSecurity
backup
Under
of this
perjury,
certify and
that:(2)
(1)I/we
the am/are
Tax Payer
withholding
because
I/weis are
exempt
fromI/we
backup
withholding,
I/we
Number
shown
on this(a)form
correct
and (2)
am/are
not subjectorto (b)
backup
have not been
notified(a)byI/we
the Internal
Revenue
I/we am/are
subject
withholding
because
are exempt
from Service
backup that
withholding,
or (b)
I/we
to backup
withholding
of aRevenue
failure toService
report all
or dividends,
have
not been
notified as
by atheresult
Internal
thatinterest
I/we am/are
subject
or backup
(c) the IRS
has notified
am/are
no longer
subject
to backup
to
withholding
as a me/us
result that
of a I/we
failure
to report
all interest
or dividends,
withholding,
and
(3)notified
I/we am/are
U.S.I/we
person
(including
a U.S.
resident
alien).
or
(c) the IRS
has
me/usa that
am/are
no longer
subject
to backup
Complete a W-8
BEN
if you
are anot
a U.S.
person.
Alternatively,
by initialing
at
withholding,
and (3)
I/we
am/are
U.S.
person
(including
a U.S. resident
alien).
the end ofa this
I/we are
acknowledge
I/weAlternatively,
am/are subject
to backup
Complete
W-8section,
BEN if you
not a U.S. that
person.
by initialing
at
withholding
therefore,I/we
certification
(2) is not
the
end of and,
this section,
acknowledge
thatapplicable.
I/we am/are subject to backup
_______ and, therefore,
_______
withholding
certification (2) is not applicable.
initial
initial
_______
_______
initial
initial
ESTABLISH THE FOLLOWING ACCOUNTS: (For new members only)
ESTABLISH
FOLLOWING
ACCOUNTS:
new members only)
Share
Account (required
$5.00 held(For
balance)
❑ OwnershipTHE
❑
❑
❑
1.
1.
2.
2.
3.
3.
Ownership
Share Account
(required $5.00 held balance)
Plus, the accounts
listed below:
Plus, the accounts listed below:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
OVERDRAFT PROTECTION:
OVERDRAFT
PROTECTION:
Protection (available from Savings products or
❑ Yes, I want Overdraft
❑
Yes,
I want
Overdraft Protection
(available
fromyour
Savings
products
or
my Line
of Credit/Credit
Card). Please
indicate
preference
below:
my Line of Credit/Credit Card). Please indicate your preference below:
TYPE OF ACCOUNT
TYPE OF ACCOUNT
1ST CHOICE
1ST CHOICE
2ND CHOICE
2ND CHOICE
CREDIT CARD: (Please select if applicable)
CREDIT
(Pleasein
select
if applicable)
am interested
applying
for a USE Platinum Credit Card.
❑ Yes, I CARD:
❑
Yes, I am interested in applying for a USE Platinum Credit Card.
TRUST ACCOUNT
If establishing a trust account, complete the following:
❑ LIVING TRUST
❑ CeRTIfICaTIoN of TRUST (DepoSITS) oN fILe
Trust Agreement Dated
Name of Trust: ____________________________________________
Trust TIN: ________________________________________________
Name of Trustor(s): ________________________________________
I/We declare under penalty of perjury and as provided under the
California Probate Code Section 18100.5 that I/we am/are qualified
and have the power to act and am/are properly exercising the powers
under the above named trust.
Trustee Signature: _______________________________________
Co-Trustee Signature: ____________________________________
I/We have received a copy of the Account Agreement and Disclosure Statement,
Electronic Services Disclosure & Statement, Member Privacy Disclosures, and
current Schedule of Fees and agree with the terms and conditions for the use of
these services. I/We authorize the Credit Union to check my/our ChexSystems
history and my/our credit history for any reason by obtaining a credit report
whenever the Credit Union has a legitimate business reason for doing so. I/We
agree that the Credit Union may access the records of the California Department of
Motor Vehicles from time to time to obtain my/our current mailing address and by
doing so agreeing I/we am/are waiving my/our rights under section 1808.22 of the
California Vehicle code. ________ ________
initial
initial
I/We agree to be bound by the terms and conditions of any account that I/we have
in the Credit Union now or in the future.
Primary Member Signature
Date
Joint Owner Signature
Date
For Living Trust Accounts: If the Trust does not name Successor
Trustees, please check the box and initial here: ❑ _______
If you wish for the Successor Trustees to serve in succession rather
than simultaneously, please indicate the order to serve by checking
the appropriate box.
Successor Trustee
❑1 ❑2
IMPORTANT:
If applying for membership remotely, signature(s) must be notarized.
Address
City
State
Date of Birth
Social Security #
www.usecu.org
Zip
(866) USE-4-YOU
(873-4968)
❑ OFAC
Successor Trustee
❑1 ❑2
CREDIT UNION USE ONLY
Opened/Updated by (Teller # / Initials)
Date:
Member #:
SD #
Address
City
State
Date of Birth
Social Security #
Zip
Primary Member
❑ OFAC
Primary ID
Type
FIDUCIARY ACCOUNT
❑ FIDUCIARY (TRUSTOR):
________________________________
❑ REPRESENTATIVE PAYEE:
______________________________
CALIFORNIA UNIFORM TRANSFER TO MINOR ACT (CUTMA)
Custodian
Signature
Name of Minor
Date of Birth
Funds to remain in Trust until age: _______
PROXY STATEMENT
I appoint the Board of Directors of USE Credit Union to appoint a Proxy to
represent me at all meetings of the members of this Credit Union. The Proxy
will vote for me on all questions and elections coming before said meeting,
to give consent and in other ways to act in my place and stead. This Proxy
shall remain in force for three (3) years from today, unless revoked by me in
writing or revoked by subsequent Proxy. This Proxy will be withdrawn from any
meeting which I attend and vote at in person.
_______
Initial (Primary Member)
Driver License / ________
❑
❑
❑
❑
❑
❑
❑
❑
U.S. Passport
Foreign Passport / _________
State
State-Issued ID Card / ______
State
Country
U.S. Military ID
Permanent Resident Card
Alien Registration Card
Matricula Consular
SENTRI Card
Birth Certificates (for minors)
❑
❑
Driver License / ________
❑
❑
❑
❑
❑
❑
❑
❑
U.S. Passport
Foreign Passport / _________
State
State-Issued ID Card / ______
State
Country
U.S. Military ID
Permanent Resident Card
Alien Registration Card
Matricula Consular
SENTRI Card
Birth Certificates (for minors)
ID# _______________ / ________
ID# _______________ / ________
❑ Existing Member
❑ Existing Member
ID Type:
ID Type:
Exp.
Secondary ID
Type
Successor Custodian Name
Joint Owner
❑
❑
Exp.
If different
from Primary
ID, address
verified with:
ChexSystems:
 No Record
Initials:
ChexSystems:
 No Record
Initials:
OFAC:
 No Record
Initials:
OFAC:
 No Record
Initials:
MEMBERSHIP CO-CHAIR USE ONLY: Verified by: _____________ Date: _____________
C.O.T. on file dated:
Reason for update:
Rev. 8/11