all-in-one membership application and agreement

Copyright Oak Tree Business Systems, Inc., 2001-2012. All Rights Reserved. of 3 OTBS 014 WEB TECH (12/12)

All-In-One Membership Application

and Agreement

Account Number

For Credit Union Use Only

Account Type:

�� Primary Savings � Secondary Savings � Checking � Money Market � Term Certificate � VUTMA � Other ___________________

Ownership Type:

� Individual � Joint � VUTMA � Association � Trust � Other ______________________________________________

Joint Account: If You are establishing a Joint Account, please check only one box below and sign where applicable:

� Joint Account with Survivorship

� Joint Account – No Survivorship

1. Primary Member Information Social Security Number (TIN)

Drivers License Number State E-Mail Address Mother’s Maiden Name

(Mr., Ms., Mrs.)

First Last M.I. Suffix Family Member of

Additional Name Information Address

City

State

Zip

Birthdate

Home Telephone

Business Telephone Employer Since Annual Income

2. Joint Owner Information (Mr., Ms., Mrs.)

First

Last

M.I. Suffix Social Security Number

Drivers License Number State

Address

City

State

Zip

Birthdate

Home Telephone

Business Telephone Employer Since Annual Income Mother’s Maiden Name

3. Additional Joint Owners (Mr., Ms., Mrs.)

First

Last



Address (if different than Primary Member)

City

State

Zip

Birthdate

Relationship To Primary Member

(Mr., Ms., Mrs.)

First

Last




City

State

Zip

Birthdate


(Mr., Ms., Mrs.)

First

Last




City

State

Zip

Birthdate


(Mr., Ms., Mrs.)

First

Last




City

State

Zip

Birthdate


4. VISA® Debit Card / ATM Card / Online Banking / VISA® Credit Card / Overdraft Protection Service Request You are requesting the following products or services be established for You:

� VISA® Debit Card � ATM Card � VISA® Credit Card(1) � Overdraft Protection(2) 1st _____________________ 2nd _____________________ � Online Banking with E-Statements(3) � Online Banking without E-Statements

(1) Refer to page 3 for important information concerning the costs of Your Card. (2) Your overdrafts will be covered by transferring funds from Your Loan/Sub Account I.D. identified above in the order specified. Example: 1st Overdraft Protection 2nd Primary Savings (3) You acknowledge that You have read, understood and agree to the terms of the Consent to Receive Electronic Documentation disclosure provided earlier.

(On the death of a party to the Account, the deceased party’s ownership in the Account passes as part of the party’s estate under the party’s will, trust, or by intestacy.)

(On the death of a party to the Account, the deceased party’s ownership in the Account passes to the surviving party or parties to the Account.)


5. VUTMA Account (Virginia Uniform Transfer to Minors Act) If You would like to establish Your Account as a VUTMA Account, please complete this section. You understand that the gift of money to the Minor named on this Application, which gift shall be deemed to include all dividends thereon and any future additions thereto, is irrevocable and is made in accordance with, and is to include all provisions of, the Virginia Uniform Transfer to Minors Act (the Act) as it is

now and in the future. You further understand that the age of delivery from the Custodian to the Minor will occur upon the minor's age of 18 or 21, under the Act. (Please circle one)

_____________________________________ as custodian for _________________________________________ (name of minor) under the Virginia Uniform Transfer to Minors Act.

Minor’s Social Security Number: ___________________________________________

6. Payable-on-Death Account If You would like to establish Your Account as a Payable-on-Death Account and You would like to designate beneficiary(ies) please fill in the appropriate section(s) below. The account owners reserve the right to change or revoke this designation at any time. In the event of Your death, You, the undersigned, hereby designate the following beneficiary(ies):

Beneficiary Name 1

Beneficiary Name 2

Street Address Street Address

City, State, Zip City, State, Zip

Social Security Number Social Security Number

7. Request to Receive Electronic Documentation �If this box is checked, You request that We provide documentation to You electronically according to the Consent to Receive Electronic Documentation provision of Your

Agreements and Disclosures, which You acknowledge that You have read, You understand and You agree to its terms. 8. Important IRS Information Under penalties of perjury, You certify that:

1. The number shown on this form is Your correct taxpayer identification number (TIN) (or You are waiting for a number to be issued to You), 2. You are not subject to backup withholding because: (a) You are exempt from backup withholding; (b) You have not been notified by the Internal Revenue Service that You are subject to backup withholding as a result of failure to report all interest or dividends; or (c) the IRS has notified You that You are no longer subject to backup withholding, and 3. You are a U.S. person (including a U.S. resident alien). Please consult IRS publication 1679 for additional information about backup withholding and a copy of IRS form W-9. Certification Instructions - You must cross out item 2 above if You have been notified by the IRS that You are currently subject to backup withholding because of underreporting interest or dividends on Your tax return.

9. Signatures You hereby apply for membership with Freedom First Federal Credit Union. You warrant the truth of the information contained in Your application for membership and/or in subsequent representations to Us. You realize that such information will be relied upon by Us in determining Your membership eligibility and/or credit worthiness. You hereby authorize Us, Our employees and agents to investigate and verify any information provided to Us by You. By signing below, You agree to be bound by the terms and conditions found within Your application for membership and to the bylaws, rules and regulations of Freedom First Federal Credit Union in effect from time to time. You further acknowledge receiving a copy of the "Agreements and Disclosures" related to Your Account(s) and You agree to be bound by the terms and conditions found therein. If You are now applying or subsequently apply for any credit product (“Feature Category”) contained in Our Credit Line Account program, You agree and understand that if approved, You are contractually liable according to the applicable terms and conditions of the Credit Line Account Agreement and Disclosure and You promise to pay all amounts charged to Your Credit Line Account according to its terms. If Your application for membership and/or for credit is a joint application, any liability created by the use of Your Account or by Your Credit Line Account is joint and several. You authorize any person, association, firm, corporation or personnel office to furnish information concerning Your affairs upon Our request, including, but not limited to, providing credit and employment history information. In addition to establishing a regular share Account, You may also from time to time request additional Accounts and/or Account Services be established on Your behalf (including the issuance of a Credit Card) and/or the addition of joint owner(s) of Your Account(s). Your signature below is Your continuing authorization for Freedom First Federal Credit Union to follow Your written or verbal instructions to do so and You agree that Your continuing authorization will remain in effect unless We receive written instructions to the contrary. You hereby authorize Us to recognize any of the signatures subscribed herein in the payment of funds or the transaction of any business for Your Account(s). CO9SE9SUAL LIE9. If You are issued a Credit Card, You grant and consent to a lien on Your shares with Us (except IRA and Keogh accounts) and any dividends due or to become due

to You from Us to the extent You owe on any unpaid Credit Card balance. The Internal Revenue Service does not require Your consent to any provision of this document other than the certifications required to avoid backup withholding.

Applicant’s (Primary Member) Signature

�

Date

Joint Owner Signature

�

Date


�

Date


�

Date


�

Date


�

Date

Please be sure to send Your application to Us at the address shown below together with at least $5.00 for your required opening minimum balance in

the form of a check or money order, plus any additional amounts you wish deposited according to Your instructions set forth herein:

Freedom First Federal Credit Union

Post Office Box 1999

Salem, VA 24153

$____________________________Regular Share Account

$____________________________Share Draft (Checking) Account

$____________________________Other_________________________(Please Specify)

For credit union use only: Employer Code

Branch Number Teller Number Received By (Initial) Date Accepted

ODP Limit

$

Approving Officer VISA Limit

$

Approving Officer


IMPORTANT CREDIT CARD DISCLOSURES. The following disclosure represents important details concerning Your Credit Card. The information about costs of the Card are accurate as of the effective date of ________________. You can call Us at (540) 389-0244 or write Us at P.O. Box 1999, Salem, VA 24153 to inquire if any changes have occurred since the effective date.

Interest Rates and Interest Charges

Annual Percentage Rate (APR) For Purchases

VISA Classic: _________% Your APR will vary with the market based on the Prime Rate.

VISA Platinum: _________% Your APR will vary with the market based on the Prime Rate.

Annual Percentage Rate (APR) For Balance Transfers

VISA Classic: _______%

Your APR will vary with the market based on the Prime Rate.

VISA Platinum: _______%


Annual Percentage Rate (APR) For Cash Advances

VISA Classic: _______%


VISA Platinum: _______%


Penalty APR And When it Applies

18.00%

This APR may be applied to Your Account if You: 1) Make a late payment. How Long Will The Penalty APR Apply? If Your APRs are increased for this reason, for transactions that you make prior to the effective date of the increase, the Penalty Rate will apply until you make the next six consecutive minimum payments when due. For transactions that you make after the effective date of the increase, the Penalty Rate may be applied indefinitely.

How to Avoid Paying Interest on Purchases

We will not charge You interest on purchases if You pay Your entire balance owed each month within 25 days of Your statement closing date.

For Credit Card Tips from the Consumer Financial Protection Bureau

To learn more about factors to consider when applying for or using a Credit Card, visit the website of the Consumer Financial Protection Bureau at http://www.consumerfinance.gov/learnmore.

Fees

Transaction Fees

• Cash Advance

• Foreign Transaction

The greater of 2.00% of each advance or $5.00

1.00% of each foreign currency transaction in U.S. dollars. 1.00% of each U.S. Dollar transaction that occurs in a foreign country.

Penalty Fees

• Returned Payment

• Over-the-Credit Limit

• Late Payment

Up to $25.00

$25.00

Up to $15.00 for unpaid balances less than $250.01, after 2 days Up to $25.00 for unpaid balances greater than $250.00, after 2 days

How We Will Calculate Your Balance: We use a method called "average daily balance (including new purchases)."

all-in-one membership application and agreement

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