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I certify that I am within the Credit Union's Field of Membership or as a family
member as defined in the Truth-in-Savings Disclosure and Account Agreements. Signing
below constitutes an Agreement to conform to the Credit Union's By-laws and the
terms and conditions of the Truth-in-Savings Disclosure and Account Agreement
and the Electronic Services Disclosure and Agreements which are incorporated by
this reference, whether applicable to products and services I am currently requesting
or those I request in the future. I may obtain a copy of these disclosures at
a COFCUbranch location or by calling the Credit Union Main Office.
These disclosures will be mailed to me by COFCU once my account has been opened.
If I, the Primary Owner, am under 17 years of age, I understand that I must
have a parent or guardian of legal age as Joint Owner on any Share Draft (Checking)
Account I have with the Credit Union. I authorize you to gather whatever credit,
checking account and employment information you consider appropriate from time
to time. I understand that this offer is based in part on the Credit Unions'
review of my credit standing.
Payee Exempt from Backup Withholding (see Part III Instructions in Truth-in-Savings Disclosure and Account Agreements).
Under penalties of perjury, I certify that 1) the information provided on this form is true, correct, and complete, and 2) I am not subject to backup withholding.
The IRS does not require your consent to any of the provisions of this document other than the certification required to avoid backup withholding.
Joint Owner's Signature ___________________________________________ Date _________
Taxpayer Identification Number (TIN)
If the account is in more than one name, see the chart in the Truth-in-Savings Disclosure and Account Agreement for guidelines on whose number to enter. Typically, this will be the Prime Owner's Social Security Number.
Certification and Backup Withholding InformationTaxpayer Identification Number (TIN)
I agree to enter my TIN in the appropriate box. For individuals, this is my Social Security Number (SSN). For most entities, it is my Employer Identification Number (EIN). If I do not have a number, I will refer to "How to get a TIN" section of the Truth-in-Savings Disclosure and Account Agreements.
Taxpayer I.D. # (Social Security or Employer I.D: ________________)
Certification
Primary Owner's Signature and Certification ___________________________ Date _________
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