Membership Application

You become a member by depositing $5.00 into your savings account and by paying a one-time $5.00 membership fee. Please provide all the requested information. When you have completed the form, click on the Submit button to send your application. Processing will take approximately one business day.

Application Information: I hereby make application for membership in The Consumers Cooperative Association and The Consumers Credit Union and I agree to conform to the bylaws and amendments thereof of each Corporation, to pay the $5 membership fee required by the Association and to subscribe to at least one share in the Credit Union.

Backup Withholding Information: Under penalties of perjury, you certify (1) that the number shown on this form is your correct taxpayer identification number and (2) that you are not subject to backup withholding either because you have not been notified that you are subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified you that you are no longer subject to backup withholding."

"The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding."

Joint Share Account Agreement: The Consumers Credit Union is hereby authorized to recognize any of the names subscribed hereto in the payment of funds or the transaction of any business for this account. The joint owners of this account, hereby agree with each other and with said Credit Union that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said joint owners to their credit as such joint owners with all accumulations thereon, are and shall be owned by them jointly, with right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge said Credit Union from any liability for such payment. Any or all of said joint owners may pledge all or any part of the shares in this account as collateral security to a loan or loans. The right or authority of the credit union under this agreement shall not be changed or terminated by said owners, or any of them except by written notice to said credit union which shall not affect transactions theretofore made.

Deposit Insurance Information: According to Public Law No. 102-242, The Federal Deposit Insurance Corporation Improvement Act of 1991, you are hereby advised that your credit union is not federally insured and if the institution fails, the Federal Government does not guarantee that you will get back your money.

Primary Owner of Account

Last Name
First Name
Middle Initial

Residential Address
City
State
ZIP Code

Mailing Address
(if different)
City
State
ZIP Code

Social Security No.
Driver's License No.
State

Home Phone
Work Phone
Date of Birth

E-Mail Address

Mother's Maiden Name

Subject to back-up withholding Yes / No

Joint Owner 1

Last Name
First Name
Middle Name

Residence Address
City
State
ZIP Code

Mailing Address
(if different)
City
State
ZIP Code

Social Security No.
Driver's License No.
State

Home Phone No.
Work Phone No.
Date of Birth

Relationship to
Primary Owner
Mother's Maiden Name

Joint Owner 2

Additional Services Desired

FREE Checking (Share Draft) Account
Debit Card
one card
two cards
ATM Card
one card
two cards
I-Banking (Home Banking)
I-Pay (Bill Payment)
Certificate
IRA
$ ($250 minimum)
1 year
15 months
2 years
30 months
3 years
45 months
4 years
5 years
Regular CD
$ ($250 minimum)
91 days
6 months
1 year
15 months
2 years
30 months
3 years
45 months
4 years
5 years
Loan
Money Market Account $
IRA Money Market $
Telephone Teller

CCU reserves the right to obtain outside consumer credit reports and inquiries through Chexsystems on the services you have applied for.

Switch Kit

Last Name
First Name
Middle Initial

Residential Address
City
State
ZIP Code

Mailing Address (if different)
City
State
ZIP Code

Social Security No.
Driver's License No.
State

Home Phone
Work Phone
Date of Birth

E-Mail Address

Mother's Maiden Name

Last Name
First Name
Middle Name

Residence Address
City
State
ZIP Code

Mailing Address (if different)
City
State
ZIP Code

Social Security No.
Driver's License No.
State

Home Phone No.
Work Phone No.
Date of Birth

Relationship to Primary Owner
Mother's Maiden Name