SHARE DRAFT INFORMATION AND APPLICATION
PRIMARY MEMBER  SSN
DRIVERS LICENSE NUMBER  STATE ISSUED
JOINT MEMBER  SSN
DRIVERS LICENSE NUMBER  STATE ISSUED
STREET ADDRESS
CITY/STATE/ZIP
HOME PHONE
(KSDFKSDJF)
 WORK PHONE
(KSDFKSDJF)
ADDITIONAL TERMS AND CONDITIONS

The Credit Union is hereby authorized to recognize any of the signatures subscribed on this application in the payment of funds or the transactions of any business for this share draft account. The joint owners of this account hereby agree with each other and with the Credit Union that all sums now paid in or shares in this account, or heretofore or hereafter paid in on shares in this account, by any or all of said joint owners to their credit union as such joint owners, with all accumulating thereon, are and shall be owned by them jointly, with right of survivorship, and shall be subject to the withdrawal and receipt of any of them, and payment to any of them or the survivor or survivors.

The right or authority of the Credit Union under this Share Draft Agreement shall not be changed or terminated by said owners, or any of them, except by written notice to the Credit Union, which shall not affect transactions theretofore made.

(Instructions to Signer: If you have been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding due to payee under reporting and you have not received a notice from the IRS that the backup withholding has terminated, you must strike out the language in clause 2 of the certification you sign below).

CERTIFICATION AS TO TAXPAYER IDENTIFICATION NUMBER AND BACKUP WITHHOLDING

Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number and (2) that I am not subject to taxpayer withholding because: (A) I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (B) Internal Revenue Service (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).


 
____________________________________
 
PRIMARY MEMBER

__________________________________
DATE


You Must Print, Sign, and Return to Credit Union
along with signed Share Draft Agreement