Checking / Savings Application

* Required Fields
Designate the Ownership/Responsibility for the Account :
Primary Account Owner Information
Social Security Number:
 -   - 
Date of Bith:
 /   / 
Primary Owner: Home Address Information

Phone Numbers and E-mail Address
Employment Information
Employed Since:
 /   / 
First Joint Account Owner Information
Social Security Number / TIN:
 -   - 
Date of Birth:
 /   / 
Phone Numbers and E-Mail Address
Employment Information
Payable on Death (POD) Beneficiary / Payee

Optional Account Services
Set up Payroll Deduction:
I have this day authorized the payroll department to deduct the following amount from my pay each period until further notice from me.:

Access your funds through the use of ATM and/or Point of sale (POS)* purchases wherever VISA is accepted.

*POS transactions require an open & funded Electronic Checking Account 

A Debit Dard will be automatically issued to the Primary Owner.

Second Debit Card:
SSN / TIN Certification and Backup Withholding Information

(A) By signing below, I certify under penalties of perjury that (1) the Taxpayer Identification Number (TIN) shown on this Membership Application Form is my correct TIN and I am not subject to backup withholding either because (a) I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends or (b) the IRS has notified me that I am no longer subject to backup withholding.

(B) I am not a U.S. person or U.S. Resident Alien. (Complete/submit a separate form, W-8 Ben) 

Agreement and Authorization
 By signing below, I/we agree to Fraternal Order of Police Federal Credit Union's by-laws and the terms and conditions of the Membership and Account Agreement, Truth-In-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment, the Credit Union makes from time to time which is incorporated herein. I/We acknowledge receipt of a copy of the Agreement and Disclosures applicable to the accounts and services requested herein. If an access card or Electronic Funds Transfer (EFT) service is required and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Funds Transfer Agreement.

I/We hereby authorize Fraternal Order of Police Federal Credit Union to verify credit and employment history by any necessary means, including access of a consumer credit report from any consumer reporting agency for any information it deems necessary for approval of this application as well as any credit products requested now or in the future. This signature applies to all accounts under my/our name(s) at Fraternal Order of Police Federal Credit Union. In compliance with the USA Patriot Act, I understand Fraternal Order of Police Federal Credit Union is required to obtain and verify identification provided for all new account owners and joint owners, using methods permitted by law.

Joint Owner Agreement: Fraternal Order of Police Federal Credit Union is hereby authorized to recognize any of the signatures subscribed hereof in the payment of funds or the transaction of any business for this account. 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 from the Credit Union.

Upon issue of a Personal Identification Number (PIN), this number should be memorized. DO NOT write it on your card or keep in your wallet/purse. After memorizing it, you should destroy it. Your accounts can be accessed by the use of the card with the PIN. If you forget your PIN, contact the Credit Union and we will issue you a new one. By the signing of this application, I acknowledge that I understand the use of my PIN/Password has the same legal effect as my written signature. I further understand that I am responsible for all transactions made through internet homebanking/bill-pay and if I disclose my PIN/Password to anyone, I am aware they have access to all of my accounts and that I am responsible for his/her transactions.

The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding.
Security Code:

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