North Jersey Federal Credit Union Membership Application
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Membership Application

In order to obtain your signature for authorizing NJFCU to process this application, you must print, sign and mail this Membership Application and TWO forms of ID from the following list. Driver's License, Employer ID, Military ID, Nursing License, College ID, County ID with photo/seal, Passport, Boat License, Health Club with photo/signature, Alien Registration Card, US Citizenship Card or papers to NJFCU.

Primary Owner
Full Name:
Social Security #:
Home Address:
City:
State:
Zip:
E-Mail Address:
Home Phone:
Date of Birth:
Employer Name:
Work Phone:
Please Select Account Type: Single Joint Minor
Joint Owner
Full Name:
Social Security #:
Date of Birth:
Home Phone:
Work Phone:
Please tell us how you are eligible to join NJFCU:
Through my employer
Through a family member   Name of family member 
Community Charter

Certification - 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 either because 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 the IRS has notified me that I am no longer subject to backup withholding (does not apply to real estate transactions, mortgage interest paid, the acquisition or abandonment of secured property, contributions to an individual retirement account (IRA), and payments other than interest and dividends.)

Certification Instructions - You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because of under reporting interest or dividends on your tax return.

I hereby make application for membership in NJFCU, and agree to conform to its bylaws and amendments thereof, copies of which have been made available to me, and to subscribe for at least one (1) share. If Life Savings Insurance is carried in connection with my account, I agree, in consideration of the credit union carrying such insurance, that any designation or change of beneficiary made by me shall only be binding upon NJFCU, if I have filed with NJFCU prior to my death, such designation or change of beneficiary, in writing, signed by me, on the form supplied by NJFCU; and, in the absence of so filing a designation of change of beneficiary, I agree on behalf of myself, my heirs, etc., to indemnify and save harmless the credit union from all loss or damage by reason of the payment of the proceeds of such insurance to such person as the credit union records show to be entitled thereto.

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

JOINT SHARE ACCOUNT AGREEMENT (*NOT TRANSFERABLE)
NJFCU is hereby authorized to recognize any of the signatures subscribed in the payment of funds or the transaction of any business for this account. The joint owners of this account hereby agree with each other and with said credit union that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said joint owners to their credit as such joint owners with all accumulations thereon, are and shall be owned by them jointly, with right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge said credit union from any liability for such payment. The joint owners also agree to the terms and conditions of the account as established by the credit union from time to time.
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.
The right or authority of the credit union under this agreement shall not be changed or terminated by said owners, or any of them except by written notice to said credit union which shall not affect transactions theretofore made.

X___________________________________________________
Applicant Signature and Date
X___________________________________________________
Joint Signature and Date
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your 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.
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