Member Application and Ownership Information

Membership Eligibility:* (required field)

AND/OR

Name of Relative:
 		Relationship:
alt

Ownership Type: Designate the ownership of the accounts and responsibility for the services requested.

 

Account Type(s):

Benefits Checking

Christmas Club

Classic Checking

Health Savings Account (HSA)

High Yield Share

IRA Savings

Money Market

Preferred Checking

Savings (Required)

Share Certificate

Special Savings

Vacation Club

Account Services

Order Checks (Credit Union of Georgia Pride of Membership Checks - $14.95)

Check Card

MARS (Free Account Access by Phone)

eBranch (Free Home Internet Banking)

Overdraft Protection:

Payroll Deduction

Direct Deposit

Senior Class

Savasaurus Club (Children up to Age 13)

Member/Owner:  (* = required field)

First Name*   M.I.
Last Name*  
Physical Address*
City*
State*
Zip Code*
Mailing Address*
(if different)
City*
State*
Zip Code*
Social Security No.* - -
ID/Drivers License No.*
ID/Drivers License State*
Date of Birth*
Mother's Maiden Name*
Home Phone* - -
Work Phone - -
Email

 

Joint Account Ownership

  1. Joint Owner. Removal of a Joint Owner requires consent of all owners, and hold Credit Union of Georgia harmless for actions regarding account access. The removed joint owner(s) relinquishes ownership interest including any membership share in the account(s). The relinquishment does not affect your obligation on any loan(s).

  2. Designate the account type(s), the ownership of the account and responsibility for the services requested.

Joint Owner on the following Account Type(s):

Savings

Checking

Money Market

Certificate

Special Savings

Special Checking

IRA Savings

 

First Name  
Last Name  
Middle Initial
Mail Address
City
State
Zip Code

Social Security No. - -
ID/Drivers License No.
ID/Drivers License State
Date of Birth
Home
Phone*		 - -
Work
Phone		 - -
Email

 

Account Designations

Payable on Death (POD)/Trust Account

All Accounts

Designate Specific Account(s):  

Beneficiary/
POD Payee:

 

Mail Address

City

State

Zip Code

UTTMA/UGMA

(as custodian for   (minor) under the Uniform Transfers/Gifts to Minors Act)

Minors's SSN/TIN:  

 

TIN Certification and Backup Withholding Information

Under penalties of perjury, I certify that:

  1. The number shown on this form is my correct taxpayer identification number,

  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 (including a U.S. resident alien).

Certification Instructions: Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on you tax return. Cross out item 3 and complete a W-8 BEN if you are not a U.S. person.

 

Election of Lending Service

Individual Credit: You must complete the Applicant section about yourself and the Co-Applicant section about your spouse if: (1) you live in or the property pledged as collateral is located in a community property state (AK, AZ, CA, ID, LA, NM, NV, TX, WA, WI); (2) your spouse will use the account; or (3) you are relying on your spouse's income as a basis for repayment. If you are relying on income from alimony, child support, or separate maintenance, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.

Joint Credit: If you are applying with another person, complete the Applicant and Co-Applicant sections.

LOANLINER Account Loan: By checking the box for LOANLINER Account/Loan below you are establishing an Open-end LOANLINER Credit Plan with Credit Union of Georgia. You can open a Credit Plan even if you are not requesting credit today. Once the Credit Plan is opened this allows you to make a loan request now or in the future. Please read the LOANLINER Credit and Security Agreement and Addendum accompanying this form.

Credit Card Account: By checking the box for the Credit Card Account below you are requesting a credit card at this time.

Please be sure to indicate below whether you prefer an individual or joint account for both accounts below.

LOANLINER Account/Loan: Individual     Joint
(Including ATM/Debit Card Access to the Account if Available)

Amount Requested $

Purpose/Collateral:  

Repayment:

Payroll Deduction     Cash

Military Allotment     Automatic Payment

Other  

Credit Card Account: Individual     Joint
(See Addendum to the LOANLINER Credit and Security Agreement for a table that includes the APR's and other required disclosures)

VISA Classic Card (from $500 to $5,000)      VISA Gold Card (from $5,000 to $15,000)       VISA Platinum Card (up to $20,000)

Name to appear on VISA Card  

Individual Account with Authorized User. Name of Authorized User  

Applicant Employment/Income/Residence Information:

Employer  
Address
City
State
Zip Code
Position/
Grade
Start Date
Hours at Work

NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered.

Employment Income:
Gross (before taxes)
Per
Other Income
Supervisor's Name
  If Self Employed, Type of Business
 

Home Owner Status:     Own   Rent   Live w/ Parents

Monthly Payment
Years at this Address

Complete for Joint Credit, Secured Credit or if you live in a Community Property State:

Married     Separated     Unmarried (Single-Divorced-Widowed)

 

Co-Applicant Information for Loan and/or Credit Card:

First Name  
Last Name
Middle Initial
Mail Address
City
State
Zip Code
  Own   Rent    Live w/ Parents
Monthly Payment
Years at this Address
Social Security No. - -
ID/Drivers License No.
ID/Drivers License State
Date of Birth
Home
Phone*		 - -
Work
Phone		 - -
Email

Co-Applicant Employment/Income:
Employer
Address
City
State
Zip Code
Position/
Grade
Start Date
Hours at Work

NOTICE: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it condisered.

Employment Income:
Gross (before taxes)
Per
Other Income
Supervisor's Name
  If Self Employed, Type of Business
 

 

Other Information About You
    APPLICANT   OTHER
    YES NO   YES NO
1. Are you a U.S. Citizen or permanent resident alien?  

2.

Do you currently have any outstanding judgments or have you ever filed for bankruptcy, had a debt adjustment plan confirmed under chapter 13, had property foreclosed upon or repossessed in the last 7 years, or been a party in a lawsuit?

3. is your income likely to decline in the next two years?  

4.

Are you a co-maker, co-signer or guarantor on any loan not listed above?

for whom:
   (Name of Others Obligated on Loan)

TO WHOM:
 (Name of Creditor)

 

STATE LAW NOTICES

OHIO RESIDENTS ONLY: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

WISCONSIN RESIDENTS ONLY: (1) No provision of any marital property agreement, unilateral statement under Section 766.70 will adversely affect the rights of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is granted or the account is opened. (2) Please sign if you are not applying for this account or loan with your spouse. The credit being applied for, if granted, will be incurred in the interest of the marriage or family of the undersigned.

X________________________________________________________________________________________________

SIGNATURE FOR WISCONSIN RESIDENTS ONLY                    DATE
SIGNATURES

1. You promise that everything you have stated above is correct. You authorize the Credit Union of Georgia to check your employment and credit history and to obtain credit reports in connection with your request for membership and/or credit and for any update, renewal or extension of the credit received. You understand Credit Union of Georgia will rely on the information above and in your credit reports. If there are any important changes, you will notify us in writing immediately. You also agree to notify us of any change in  your name, address or employment within a reasonable time thereafter.

2. By signing below you acknowledge that you will receive by mail, the following agreements and disclosures; the Membership and Account Agreement and the Truth in Savings Rate and Fee Schedule, which apply to any share, share draft/checking, certificates or other share accounts you open; the Funds Availability Policy Disclosure, which applies to any share draft/checking accounts you open; the Electronic Funds Transfer Agreement and Disclosure, which applies to any electronic fund transfer (EFT) services you obtain; and the LOANLINER Credit and Security Agreement, including the Addendum and Credit Insurance Certificate, which applies if you open a loan account. Your signature below means you agree to the terms and conditions of the disclosures/agreements that apply to any EFT service, share account, or loan account you have requested in this application and which you obtain from us.

3. If you are applying for a credit card, you understand that the use of your credit card will constitute acknowledgement of receipt and agreement to the terms of the credit card agreement and disclosures.

4. If you are applying for a LOANLINER Plan, you grant us a security interest in all individual and joint accounts you have with us now and in the future to secure what you owe under the LOANLINER Credit and Security Agreement and if you have applied for a Credit Card, under the Credit Card Agreement. When you are in default you authorize us to apply the balance in these accounts to any amounts due. Shares and deposits in an Individual Retirement Account, and any other account that would lose special tax treatment under state or federal law if given as security, are not subject to the security interest you have given in your shares and deposits.

5. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

__________________________________________________

SIGNATURE                            DATE

__________________________________________________

SIGNATURE                            DATE

__________________________________________________

SIGNATURE                            DATE

__________________________________________________

SIGNATURE                            DATE

Upon completion of this application, please fax or mail in a printed copy of this completed application with the appropriate signatures and CLEAR copies of two forms of I.D. of all primary and joint signers to Member Services at 678-486-1191 or mail the above information to
Credit Union of Georgia, P.O. Box 2148, Woodstock, GA 30188:

Minimum deposit for each account requested:

  • Savings Accounts: $10 (minimum required to join Credit Union of Georgia)
  • Checking Accounts: $25
  • High Yield Share and Certificate Accounts: $500
  • Money Market Accounts: $2,500

Please contact our MAPS (Mail and Phone Service) department with any questions at 678-486-1111.
Credit Union of Georgia USE ONLY:

Date of Membership:_______________

Opened/Approved by:_______________

Member Verification:_______________

__ Credit Report

__ Access Card

__ Check Verify

__ Audio Response

__ PIN Request

__ eBranch Internet Banking