North Star Community Credit Union : Membership Application

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Membership Application

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Click Here to Download PDF Version of Membership Application.

Please fill out and return to your nearest North Star Community Credit Union Branch.

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 drivers license or other identifying documents.

Please fill in all fields on the applicaton. This form is secure, and we will not share this information with any outside agency. The information you provide to us is protected by our privacy policy and federal law.

APPLICANT #1
Today's Date:
Full Name:
Relationsip to Account (Owner, Signer, etc.)
Email
Street Address:
City:
State:
Zip:
Joint Applicant:
Home Phone
Work Phone
SSN:
Date Of Birth:
Tax ID Number:
Employer's Name
Employer's Address
Previous Financial Institution

APPLICANT #2
Full Name:
Relationsip to Account (Owner, Signer, etc.)
Email
Street Address:
City:
State:
Zip:
Home Phone
Work Phone
SSN:
Date Of Birth:
Tax ID Number:
Employer's Name
Employer's Address
Previous Financial Institution

The Taxpayer Identification Number (TIN) shown above is my correct Taxpayer Identification Number.

I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding.

I am an exempt recipient under the Internal Revenue Service Regulations.

I am eligible for membership because: (Check all that apply)


	I live within 75 miles of Maddock, or a 50 mile radius of Rugby, Bottineau, or Cavalier.
	I was once a member.
	I have immediate family that is a member.

Ownership of Account


	Single Party Account
	Multiple-Party Account
	Corporation - For Profit
	Corporation - Nonprofit
	Partnership
	Sole Proprietorship
	Limited Liability Company

Beneficiary Designation


	Single Party Account
	Single-Party Account with Pay-On-Death (POD)
	Multiple-Party Account with Right of Survivorship
	Multiple-Party Account with Right of Survivorship and POD

Upon receipt of your application we will send you a membership card that requires your signature.

We require a signed membership card returned along with a deposit of $25.00 into your share account before we can process transactions. If you are already a member do not complete this application. Thank you!