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Checking/Savings Account Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

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The items marked with (*) are required fields.


Account Information
Will there be a co-applicant on this application?   Yes No
(If Yes, the co-applicant section has the same required fields as the primary applicant.)
I am interested in:
Checking Account
Type of Checking Account:
Benefits Plus:
      "Enhance my checking with Benefits Plus"
Free Checking
Green Checking
Tiered Rate Checking
High-Rate Checking
Initial Deposit Amount $
Source of Deposit:
   Transfer from a current account
         Account Number

   I will transfer funds from another financial institution
   I will mail a check/money order
   Other (please describe)
Savings Account
Type of Savings Account:
Regular/Club Share
IRA
HiYield Savings
Money Market Account
Premier Savings

Initial Deposit Amount $
Source of Deposit:
   Transfer from a current account.
         Account Number

   I will transfer funds from another financial institution
   I will mail a check/money order
   Other (please describe)
Other Account
Description

Initial Deposit Amount $
Source of Deposit:
   Transfer from a current account.
         Account Number

   I will transfer funds from another financial institution
   I will mail a check/money order
   Other (please describe)

I am also interested in:
ATM Card
Check/Debit Card
Bill Pay
Credit Card
Direct Deposit
Other (please describe)

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Primary Applicant
*Member Number
*Last Name
*First Name
Middle Name
*Social Security Number (TIN) --
*Date of Birth //
*Home Phone Number --
Work Phone Number -- ext.
Number -- ext.
Email Address
 
Drivers License #
Drivers License State
 
Mother's Maiden Name
 
Present Employer Name
 
Home Address
*Address 1
Address 2
*City
*State
*Zip -

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Additional Information
How would you prefer to be contacted?
Home Phone
Work Phone
Cell Phone
Email Address
Other
Special Instructions/Comments

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By submitting this form, I authorized Financial Plus Credit Union to obtain a credit report and verify my employment information. Upon receipt of this form, Financial Plus Credit Union will review my checking/savings application and upon approval, will forward documentation to me for original signatures.


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