Northside FCU Member Application

Under penalties of perjury, applicant signing below certifies that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 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 withholding, and 3. I am a U.S. Person (U.S. Citizen or Resident Alien). I understand that if I am not a U.S. Person, but a Non-Resident Alien, I must submit the appropriate IRS Form W-8BEN with the membership application. The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Consent for Electronic Communication – the applicant signing bellows affirmatively agrees and authorizes Northside Federal Credit Union (NFCU) to conduct business with them electronically. This disclosure documents the applicant signing below gives consent to conduct transactions electronically and receive electronically online disclosures and notices related to the account(s) applicant is applying to open with NFCU and other products or services that NFCU may offer from time to time. This disclosure also describes applicant’s rights relative to conducting transactions electronically and receive electronically disclosures and notices, in addition to the consequences of withdrawing such consent. Please keep a copy of this disclosure and all other disclosures and agreements related to any accounts with NFCU. This information may include, but is not limited to the following: • Account Alerts • Annual Privacy Notice with opt-out option • Billing rights • Disclosures • E-documents (E-statements, E-notices, and E-receipts) • Notice of changes in terms for your share account(s) • Notice of changes in fee schedule • Terms and Conditions of your share accounts • Truth-In-Savings The applicant signing below certifies they are applying for membership with NFCU as well as the accuracy of the information provided and acknowledges receipt of a completed copy of this form. The applicant signing below authorizes NFCU gather credit, checking account, and employment information as deemed necessary from time to time in order to assist in determining initial and ongoing eligibility for share account(s) and/or in connection with making credit opportunities available, either now or in the future. The applicant signing below agrees that this is an application for membership in NFCU, and applicant certifies eligibility for membership in NFCU field of membership. All of the information on the application is accurate and truthful, and the account is subject to closure if provided false information. All applicants and beneficiaries will undergo an OFAC screening. By signing this membership application, I give Northside Federal Credit Union authorization to update my member number in the event that my employee number changes. I authorize information provided by Northside Hospital to validate the change. With this application is my initial $25 required share deposit; or, attached is payroll deduction form. The $25 required share deposit is a mandatory minimum balance in your savings account at all time; if not maintained, NFCU can terminate your membership. This form will supersede any previously dated form on file.