Membership Application

Refered By:

Account Number:

Date Opened:

Office Use Only

Office Use Only

Membership Eligibility

Catholic Aid Association Member -

Select Employee Group -

(Please note: If you reside in the state of North Dakota, please list your parish name here: )

Related to a CAA Credit Union Member -

Account Requested

Indicate Ownership

Personal Account

Revocable Trust

Uniform Transfer to Minor

Primary Member Information

Name:

Date of Birth:

City/State of Birth

//

Home Address

Home Phone

Business Phone

Mobile Phone

Email Address *Required Field

Preferred Contact Method

Mothers Maiden Name

Drivers License Number

Social Security Number/Tax ID Number

Name of Relative/Friend Not Living With You

Phone Number

Joint Applicant

Name:

Date of Birth:

City/State of Birth

//

Home Address

Home Phone

Business Phone

Drivers License Number

Social Security Number/Tax ID Number

Joint Applicant #2

Name:

Date of Birth:

City/State of Birth

//

Home Address

Home Phone

Business Phone

Drivers License Number

Social Security Number/Tax ID Number

Beneficiary Designation

Name:

Date of Birth:

City/State of Birth

//

Home Address

Home Phone

Business Phone

Drivers License Number

Social Security Number/Tax ID Number

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 verify your identity through a credit report or other electronic verification systems.

By pressing the submit button below, I/we agree to the terms and conditions of the Membership and Account Agreement brochure and the Truth-in-Savings Rate and Fee Schedules. I/we understand that the terms of any account I/we have with CUFCU may change from time to time, and I/we agree to such changes at the time they are made. I/we certify that the information provided on this application is true and correct and I/we authorize you to contact any source necessary to verify any information on this application, eligibility for membership, and my/our credit history. I/we understand that you will retain this application whether or not it is approved.

I have read, understand, and accept the Membership Account Agreement.

Would you like us to pull a credit report to see if we could save you money on your loans?

Yes No

Backup Withholding Certification
Under Penalties of perjury, I certify the taxpayer identification number shown above (Social Security No.) is my correct tax payer identification number and I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding.

**Please include a legible photocopy of your driver's license with your printed and signed application.**


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