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 all financial institutions 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 for your name, address, date of birth, and other information that will allow us to identify you.

We may also ask to see your driver's license or other identifying documents.

All new accounts are verified through E-Funds.



Primary Applicant

*Membership Eligibility:
I am eligible for membership because I:
Live in the Bristol, Barnstable, or Plymouth county
Work in the Bristol, Barnstable, or Plymouth county
Attend school in the Bristol, Barnstable, or Plymouth county
A family member residing in the same household of a credit union member
Name of credit union member:
A family member (grandparent, parent, spouse, sibling, child or grandchild) not residing in the household of the credit union member
Name of credit union member:
Currently work for a telephone company

*Last Name
*First Name
Middle Name

*Residence Address (not P.O. Box)
*City
*State
*Zip Code

Mailing Address (if different)
City
State
Zip Code

*Social Security No.
*Driver's License No.
*State

*Home Phone Number
Work Phone Number
*Date of Birth

E-mail Address

*I AM / Am Not Subject to back-up withholding

*Homeowner Yes / No

*Mother's Maiden Name


Joint Owner 1

Last Name
First Name
Middle Name

Residence Address (not P.O. Box)
City
State
Zip Code

Mailing Address (if different)
City
State
Zip Code

Social Security No.
Driver's License No.
State

Home Phone Number
Work Phone Number
Date of Birth

E-mail Address

I AM / Am Not Subject to back-up withholding

Homeowner Yes / No

Mother's Maiden Name


Joint Owner 2

Last Name
First Name
Middle Name

Residence Address (not P.O. Box)
City
State
Zip Code

Mailing Address (if different)
City
State
Zip Code

Social Security No.
Driver's License No.
State

Home Phone Number
Work Phone Number
Date of Birth

E-mail Address

I AM / Am Not Subject to back-up withholding

Homeowner Yes / No

Mother's Maiden Name


Additional Services Requested

Checking Account
MasterMoneyTM ATM/Check Card-Primary
MasterMoneyTM ATM/Check Card-Joint


I (we) hereby authorize the Credit Union to verify information contained herein by any necessary means pertaining to membership and for any accounts and services requested now or in the future. I (we) certify that the information provided on this application is true and correct and I(we) agree to abide by the terms and conditions applicable.


* indicates a required field