Membership Application Form * Required Fields IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT To help the government fight the funding of terrorism and money laundering activities, Federal Law requires us to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask your name, address, date of birth and other information that will help us to identity you. We will ask to see your driver’s license or other identifying documents. MEMBERSHIP ELIGIBILITY (CHECK ONE) Eligibility: Select... New Member or Retired Teamsters Immediate Family member to an Active or Retired Teamsters Existing NETFCU Member Other Teamsters Local #: Employer: City/Town: Paystub Showing Union Dues are Paid or Current Union Membership Receipt: Immediate Family Member's Name: Immediate Family Member's NETFCU Account Number: If other, please explain: TYPE OF ACCOUNT(S) REQUESTED Account Type: Individual Account Joint Account with Rights of Survivorship DEPOSIT ACCOUNTS & OPTIONS: Savings Account Free Checking Account Club Account Money Market Account Certificate of Deposit VISA Debit Card (Checking Account required) Box of Checks (1 Box Free per Year-Checking Account required) ID Safe (Monthly Fees Apply) Courtesy Pay Program (Monthly Fees Apply) Bill Pay (Monthly Fees May Apply) Primary Owner's First Name: Primary Owner's Middle Name: Primary Owner's Last Name: Member/Account Number (If Existing NETFCU Member): Physical Address: Physical Address 2: City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Mailing Address if Different than Above: Mailing Address if Different than Above 2: City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Cell Phone Number: Home Phone Number: Mother's Maiden Name: Email Address: Social Security Number: Social Security Number: Social Security Numer Field 1 - Social Security Number: Social Security Numer Field 2 - Social Security Number: Social Security Numer Field 3 Date of Birth: Place of Birth: Employer Name: Type of ID: Driver's License (or State-Issued ID) Passport U.S. Armed Forces ID Permanent Resident Alien Card ID Number: State/Country of Issue: Date of Issue: Expiration Date: Unexpired Photo ID FRONT: Unexpired Photo ID Back: Joint Account Information Joint Owner Name's First Name: Joint Owner Name's Middle Name: Joint Owner's Last Name: Physical Address: Physical Address 2: City: State: Select... AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: Cell Phone Number: Home Phone Number: Mother's Maiden Name: Email Address: Social Security Number: Social Security Number: Social Security Numer Field 1 - Social Security Number: Social Security Numer Field 2 - Social Security Number: Social Security Numer Field 3 Date of Birth: Place of Birth: Employer Name: Type of ID: Driver's License (or State-Issued ID) Passport U.S. Armed Forces ID Permanent Resident Alien Card ID Number: State/Country of Issue: Date of Issue: Expiration Date: Joint's Unexpired Photo ID Front: Joint's Unexpired Photo ID Back: Depositor(s) hereby agree(s) to the rules and regulations governing accounts with New England Teamsters Federal Credit Union as they now are or hereafter may be altered or amended. I (We) acknowledge receipt of Funds Availability Notice and Truth-In-Savings Notice. I/We hereby authorize this Credit Union to obtain consumer reports from consumer reporting agencies or others in connection with this account. If I (we) am (are) applying for a debit card, I (we) hereby acknowledge and agree to the ATM/Debit Card Holder provisions in All About Your Deposit Account and Fee Schedule and request that a New England Teamsters Federal Credit Union Visa Check/Debit Card(s) be issued on my (our) account. Transfer of Funds To complete the online account opening process, you will need to make an initial deposit into your account(s). The bottom of this screen will require you to provide information from an existing financial institution to make an automatic transfer. Once your application for membership has been approved, we will process the transaction electronically into your new savings account with NETFCU. Savings Account $5.00 minimum deposit to open. $100.00 to avoid a monthly $1.00 fee. Name of Financial Institution: Routing & Transit Number: Account Number: Account Type: Checking Savings First Name: Last Name: *$5.00 minimum deposit required for initial deposit. $100 minimum balance required to avoid $1.00 monthly fee. Dollar amount you wish to transfer: CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER (TIN) Under penalties of perjury, I certify that: The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 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 I am no longer subject to backup withholding, and I am a U.S. person (including a U.S. resident alien). Certification Instructions: You must cross out item #2 (on above) 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. For real estate transactions, item #2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (Do not sign if you are NOT a U.S. citizen or resident alien — please use Form W-8.) Social Security Number or Employer ID Number (EIN): I hereby certify : The above information is true and accurate. Security Code: Security Code Go to main navigation
