Neighborhood Community Federal Credit Union on the Web

Membership Application
Privacy Policy

Account Type

Share/Savings
Share Draft/Checking
Share Certificate/Certificate
Money Market
Other

TIN Certificate and Backup Withholding Information
I certify, in accordance with the IRS W-9 instructions provided by the Credit Union and other penalties of perjury, that the Social Security number (SSN) /Taxpayer identification number (TIN) shown is my/the current identification number and that I am NOT, unless designated below, subject to backup withholding because I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding.

I am subject to backup withholding
Exempt
I am not a United States citizen or resident

Member Application and Ownership Information

Member
Street
City
State
Zip
Home Phone
Work Phone
Employment
Eligibility for Membership
SSN/TIN
Driver's License No.
Date of Birth
Mother's Maiden Name

Account Services

Payroll Deduction/Direct Deposit
Overdraft Protection
ATM Card
Debit Card
Other EFT Services
Other

Account Ownership

Single Party
Multiple Party with Survivorship
Multiple Party without Survivorship
Joint Owner Name
Address
City
State
ZIP
SSN/TIN
Drivers License No.
Date of Birth
Mothers Maiden Name
Home Phone
Work Phone
Account Designators
Pay on Death (POD) Trust Account
All Accounts
Designate Specific Accounts
Beneficiary
Street
City
State
ZIP
UTTMA/UGMA
Custodian for (Minors Name)
Minor's SSN/TIN
Agency
Name of Agent
All Accounts
Designate Specific Account(s)

Authorization

By submitting this form, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Rates and Fee Schedule, Funds Availability Policy Disclosures, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/we acknowledge receipt of a copy of the Agreement and Disclosures applicable to the account and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Funds Transfer Agreement found on the disclosures page of this website. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.