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Apple Credit Application - PDF

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					MemberApp.ART.12.05       12/15/05       12:52 PM   Page 1




                                                                                                                                  Newe Account
                                                                                                                                   M mber
   YES!               I would like more information
                                                                               P.O. Box 1200 • Fairfax, VA 22038-1200
                                                                                                                                    P P         C A     I N
                                                                                                                                  A A P PL L II C A TTI O O N

                  about Apple Federal Credit Union.                                 703-788-4800 • 800-666-7996
                                                                                   www.applefcu.org
   Please Print Clearly
                                                                               Apple Branches to Serve You
                                                                            The following locations offer free ATM withdrawals:
                                                                                              Centreville
   Name                                                                     13860-E Braddock Rd. • Centreville, VA 20121
                                                                                                 Fairfax
                                                                                 9701 Main Street • Fairfax, VA 22031
   Address
                                                                                     Fair Oaks Headquarters
                                                                               4029 Ridge Top Rd. • Fairfax, VA 22030
   City                          State               Zip Code                                Falls Church
                                                                           313 Park Avenue, #G9 • Falls Church, VA 22046
   Place of Employment                                                              George Mason University
                                                                            Johnson Center, Room 118 • Fairfax, VA 22030
                                                                                               Herndon
                                                                                905 Alabama Dr. • Herndon, VA 20170
   Please send me additional information on:                                                   Manassas
                                                                              8745 Mathis Avenue • Manassas, VA 20110
             Checking/Visa Check Cards/ATM Card
                            ®
                                                                                             Mt. Vernon
             24-Hour Convenience Services                                      4010 Maury Place • Alexandria, VA 22309
                                                                                              Springfield
             Visa® Credit Card                                                5417B Backlick Rd. • Springfield, VA 22151
                                                                                                Stafford
             Personal Automated Teller (PAT) Service                           37 Stafford Avenue • Stafford, VA 22554
             Consumer Loans                                                        Van Ness* - photo ID required
                                                                      4000 Connecticut Ave., NW • Washington, DC 20008
             Auto Loans                                                                      Winchester
                                                                             1850 S. Loudoun St. • Winchester, VA 22601
             Home Loans                                                                      Woodbridge
                                                                          14229 Potomac Mills Road (Potomac Festival Center)
             Financial Planning — Tax & Investments                                   Woodbridge, VA 22192
             Money Market Accounts
                                                                                  Shared Branch Locations
             Club Accounts                                                  The following locations offer free ATM withdrawals:
                                                                                             Falls Church
             Other ______________________________                           1118 W. Broad Street (Route 7, West Falls Plaza
                                                                                 Shopping Center), Falls Church, VA
                                                                                              Springfield
                                                                                6314 Springfield Plaza, Springfield, VA
                                                                                             Woodbridge
                                                                           14527 Jefferson Davis Hwy (Featherstone Square)
                                                                                           Woodbridge, VA
                  www.applefcu.org                                                        Marlow Heights
                                                                    4003 Branch Avenue (Marlow Heights Shopping Center)
    Fill in and mail it to P.O. Box 1200, Fairfax, VA 22038                        Marlow Heights, MD
                                                                12/05
                 or bring it to the credit union.               5M
                                                                                   *This location does not have an ATM.               A Better Grade of Banking.
                                                                AFCU-06
MemberApp.ART.12.05                       12/15/05         12:52 PM            Page 2




                                                                                                                                                                                              14      Membership and Share/Savings Application
                                                                    New                           Joint Owner(s) Information (continued)
                                                                                                                                                                                                      (this section must be completed)

                                                                                                                                                                                                      By signing below, I/we hereby make application for membership in Apple Federal
                                                                Account                           JOINT OWNER (2) NAME                                                                                Credit Union and agree to the terms and conditions of the Membership and
                                                                                                                                                                                                      Account Agreement, Truth in Savings, Rate and Fee Schedule, Funds Availability
                                                             Application                          BIRTH DATE                                SOCIAL SECURITY NUMBER                                    Policy Disclosure, if applicable, and to any amendment the credit union makes from
                                                                                                                                                                                                      time to time which are incorporated herein. I/We acknowledge receipt of a copy of
                                                                                                  Home Phone                                          Work Phone                                      the Agreements and Disclosures applicable to the accounts and services requested
   Opening Your Account Is As Easy As…                                                                                                                                                                herein. If an access card or EFT service is requested and provided, I/we agree to the
                                                                                                  ❐ Savings              ❐ ATM Card                  ❐ Checking               ❐ Visa Check Card*      terms of and acknowledge receipt of the Electronic Funds Transfer Agreement.
   1. Complete information inside application.
   2. Attach a copy of your driver’s license or photo ID.                                         *Checking account required.
                                                                                                                                                                                                      Apple Federal Credit Union is hereby authorized to recognize any one of the
   3. Mail or bring this application with your minimum $5 deposit.                                                                                                                                    signatures subscribed hereto in the payment of funds or the transaction of any business
                                                                                                  FREE eStatements                                                                                    for this account. The joint owners of this account hereby agree with each other and
   Failure to follow these steps will delay the processing of your application.                   
                                                                                                  ❐ eStatement Agreement — I elect to obtain my Apple FCU account information                         with said credit union that all sums now paid in on shares, or heretofore or hereafter
                                                                                                       online only (eStatements). I understand that Apple FCU will mail me a paper account            paid on shares, by any or all of said joint owners to their credit as such joint owner, with
           Important Information About Procedures for Opening a New Account                                                                                                                           all accumulations thereon, are and shall be owned by them jointly, and be subject to the
      To help the government fight the funding of terrorism and money laundering                       statement at any time, upon request (a fee may apply). Apple FCU will not disclose or sell
                                                                                                                                                                                                      withdrawal or receipt of any one of them and payment to any one of them or the
      activities, Federal law requires all financial institutions to obtain, verify, and record        any personal information to third parties, excluding credit union affiliates, concerning
                                                                                                                                                                                                      survivor(s) or the estate(s) of the deceased joint owner(s) — according to the type of
      information that identifies each person who opens an account.                                    my account.                                                                                    joint share account selected, as evidenced by the signatures below — shall be valid and
      What This Means for You: When you open an account, we will ask you for your
                                                                                                       Email Address ___________________________________________________________                      discharge said credit union from any liability for such payment.
      name, address, date of birth, and other information that will allow us to identify you.
      We may also ask to see your driver’s license or other identifying documents.                ❐ I do NOT wish to receive eStatements. I will receive paper statements in the mail.                A joint owner who is an Apple FCU member may pledge all or any part of the
                                                                                                                                                                                                      shares in this account as collateral security for a loan or loans and the credit union is
   Eligibility for Membership (check one)                                                         Requested Products & Services (check all that you are interested in)                                authorized to apply shares at any time against any indebtedness owing to it by any
   ❐ Employer _______________ ❐ Student _______________ ❐ Alumni _________________                                                                                                                   of the joint owners. If joint ownership is desired, all joint owners must complete the
                                                                                                  ❐ Savings            ❐ ATM Card        ❐ Phone/Net Branch (web banking)
                                                                                                                                                                                                      information in the space provided. NOTE: All joint owners must agree to the
                                                                                                  ❐ Visa Check Card ❐ Advantage Checking ❐ A+ Checking
   ❐ Household/Family Member: Name _____________________________________________                                                                                                                      same type of joint ownership.
                                                                                                  ❐ eXtras Student Checking
   Relationship ____________________________ Acct. #________________________________                                                                                                                  This account shall be governed by applicable Virginia Laws, Federal Laws, Rules &
                                                                                                  How did you hear about Apple FCU?                                                                   Regulations, and the By-laws of the credit union & any amendments thereto.
   Account Type (check one)                                          Account No.                  ❐ Employer                    ❐ Advertisement           ❐ Newsletter                                Statutory Lien: If you are in default on a financial obligation to us, federal law gives
                                                                                                  ❐ Web site                    ❐ Word of mouth           ❐ Other __________________________
                                                                                                                                                                                                      us the right to apply the balance of shares and dividends in your account(s) at the
   ❐ Individual ❐ Joint Account with Survivorship                                                                                                                                                     time of default to satisfy that obligation. Once you are in default, we may exercise
   ❐ Joint Account without Survivorship                                                                                                                                                               the right without further notice to you. If at any time you cause Apple Federal
                                                                                                                                                                          Account No.                 Credit Union a loss due to breaking an agreement or fraud (i.e. loan default,
   Member Information                                                                             Check Order Form (Please Print)                                                                     forgery, etc.) your service usage will be limited. Further, by submitting this
                                                                                                                                                                                                      application you consent to allow the credit union to obtain your consumer reports
   FULL NAME                                                                                      Name                                                                                                and verify your employment history and other personal information in connection
                                                                                                                                                                                                      with this application or for related financial services.
   BIRTH DATE                                 SOCIAL SECURITY NUMBER                              Name
                                                                                                                                                                                                      I hereby certify that this information is true and correct under penalty of
                                                                                                                                                                                                      perjury.
   Mailing Address                                                                                Address
                                                                                                                                                                                                      Under penalties of perjury, I certify that the Social Security Number I have
   City, State, Zip                                                                               City                                            State                        Zip Code               listed is my correct number and I am not subject to backup withholding. The
                                                                                                                                                                                                      Internal Revenue Service does not require your consent to any provision of
   Home Phone                                       Work Phone                                    Other information to be printed on check (e.g. phone) ______________________________                this document other than the certifications required to avoid backup
                                                                                                                                                                                                      withholding.
   Email Address                                                                                  Check Start # ________________________                                  Member Initials
                                                                                                                                                                                                      X
                                                                                                                    COUNSELOR/TELLER NO. DATE ____ /____/____                    Advantage Checking
   Employer                                                                                                                                                                                           ACCOUNT OWNER Signature                                                 Date
                                                                                                                                            Check Type Code________              A+        FBX
   Driver’s License Number and State (I.D.)                                                                                                                                                           X
                                                                                                  For Office Use Only                                                                                 JOINT ACCOUNT OWNER (1) Signature                                       Date
   Joint Owner(s) Information
                                                                                                  Deposit Amount                                     Insurance Form                                   X
                                                                                                                                                                                                      JOINT ACCOUNT OWNER (2) Signature                                       Date
   JOINT OWNER (1) NAME                                                                           ID                                                 Member Group

                                                                                                  Counselor/Teller No.                               Chex Systems Clearance
                                                                                                                                                                                                                         Before mailing, remember to:
   BIRTH DATE                                 SOCIAL SECURITY NUMBER
                                                                                                                                                                                                                                   • Sign and date Application
   Home Phone                                      Work Phone
                                                                                                  Date                                               Card Number                                                                   • Enclose copy of Photo ID
   ❐ Savings             ❐ ATM Card               ❐ Checking               ❐ Visa Check Card*     Branch                                             Membership Officer                                                            • Include $5 Deposit

				
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Description: Apple Credit Application document sample