1440 Rosecrans Ave.
Manhattan Beach, CA 90266
800.854.9846 • www.kinecta.org SIGNATURE CARD
This form is required in order for Kinecta to accept and process written requests such as checks, address
changes, verification of deposits, etc. Please bring completed form to any Kinecta Member Service Center or mail
to 1440 Rosecrans Avenue, Manhattan Beach, CA 90267-9935, Attn: Account Services. Or fax to 310.727.8218.
Please use blue or black ballpoint pen. Print name(s) clearly in capital letters, then sign next to the X. Include
fiduciary capacity title, if applicable.
MEMBER NUMBER: TITLE OF ACCOUNT (i.e. General Membership, Trust, CUTMA, Conservatorship, etc.):
SELECT APPLICABLE OPTION:
q New Account* q Add New Joint Owner(s)* q Update Primary or Joint Signature(s)
*Only for use if account was opened/added online
PRIMARY MEMBER NAME (First, Middle, Last): ID NUMBER: EXP DATE:
PRIMARY MEMBER SIGNATURE DATE:
JOINT OWNER #1 NAME (First, Middle, Last): ID NUMBER: EXP DATE:
JOINT OWNER #1 SIGNATURE DATE:
JOINT OWNER #1 SHARE ID(S):
JOINT OWNER #2 NAME (First, Middle, Last): ID NUMBER: EXP DATE:
JOINT OWNER #2 SIGNATURE DATE:
JOINT OWNER #2 SHARE ID(S):
PLEASE NOTE: This form can only be used to authenticate member signatures. It cannot be used in lieu
of a Membership Application to add joint owners or make any other account changes. This form will not be
used to determine account ownership or vesting.
For Credit Union Use Only
EMPLOYEE NAME: TELLER NO.: MSC: