Membership Application

USA PATRIOT Act - Customer Identification Program Notification:
Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account, in order to help the government fight the funding of terrorism and money laundering activities. 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.

Getting Started
Account Ownership


$
Minimum $10 ($5 Membership Fee/$5 Minimum Balance) for Savings Only.
Please provide your Routing Number and Account Number if you'd like us to pull the intial deposit amount via ACH from an existing account you have with another financial institution.
Accounts & Services
I/We authorize Green Country FCU to open the following accounts:
Account Services
Owner Information
Primary Account Owner

(Do not use P.O. Box)
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(-
(-
(mm/dd/yyyy)
(mm/dd/yyyy) (mm/dd/yyyy)
Joint Account Owner

(Do not use P.O. Box)
(-
(-
(-
(mm/dd/yyyy)
(mm/dd/yyyy) (mm/dd/yyyy)
Employment Information
Primary Account Owner
Joint Account Owner
Beneficiaries
Upon death of the last surviving account holder, the balance in this account shall be paid to:
Beneficiary 1
(-
(mm/dd/yyyy)  
 
Beneficiary 2
(-
(mm/dd/yyyy)  
 
Green Country FCU Can Help Save You Money!


Authorizations & Disclaimers
Under penalties of perjury, I certify that:
  1. The numbers shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued),
  2. I am not subject to backup withholding because : (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup witholding, and
  3. I am a U.S. person (including a U.S. resident alien).
Authorizations


Application Submission
Electronic Submission
Being within the field of membership, I/we hereby apply for membership in the Green Country Federal Credit Union and agree to conform to its bylaws and amendments thereto; subscribe for at least one share; and agree to the conditions printed in this form.
By clicking submit below, I/we agree to be bound by the Green Country FCU's bylaws, and all rules, regulations, terms and conditions governing this account, and all amendments thereto which may be in effect from time to time. A Membership Disclosure information brochure will be provided to me/us. Green Country Federal Credit Union is hereby authorized to recognize any of the signatures subscribed hereto in the payment of funds or the transaction of any business for this account. I/We authorize you to obtain information about me/us from credit reporting sources, and report my/our experience with this account to credit bureaus and others who may inquire about my/our experience with this account. You may also request or use subsequent consumer reports in connection with a review, update, renewal or extension of my/our accounts without additional notice to me/us.
 
How would you like to complete your application?