FCEFCU New Account Application Step 1 of 250%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. 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 ask to see your driver's license or other identifying documents. We may also verify your identity through a credit report or other electronic verification systems.Account(s) To Open* Share Savings (basic savings) - required for membership FCEFCU Checking Money Market Savings CD Loan Other**If Other, please describeAccount OwnershipSingleJointApplicant InformationName*Social Security #Date of BirthAddress* Street Address City State ZIP Email Address* Drivers LicenseState IssuedExpiration DateWork PhoneHome/CellEligibility* I am a relative of a current FCEFCU member. I am related to someone who is eligible for membership. I am part of a select employee group. I'm not sure if I qualify for membership. Co-Applicant InformationName*Social Security #Date of BirthAddress* Street Address City State ZIP Email Address* Drivers LicenseState IssuedExpiration DateWork PhoneHome/CellThe Final Step...Referral RewardsIf you were referred by an existing member, please list the member(s) name(s).Regulatory DisclosuresUnder penalties of perjury, I certify that: 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. I am a U.S. citizen or other U.S. person. (Complete a W-8 BEN if you are not a US person.)Within the last twelve (12) months, have you (or joint owner) had a checking account or other account closed?YesNoIn the past 24 months, have you (or joint owner) been convicted of a criminal offense involving the use of a check or similar instrument?YesNoAdditional NotesDownload FCEFCU DisclosuresI have downloaded the FCEFCU disclosure document. I have read, understood, and agree to be bound by the terms of the FCEFCU’s disclosures and any agreement associated with these products and services.Disclosure Confirmation* I AGREE-----------------------------------By signing in the box(es) below, you agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendments the Credit Union makes from time to time which are incorporated herein. If an access card or EFT services are requested and provided, you agree to the terms of and acknowledge the receipt of the Electronic Funds Transfer Agreement. If you knowingly make any false material statements on this account application, you may be guilty of perjury. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.Applicant's Signature*Co-Applicant's Signature*EmailThis field is for validation purposes and should be left unchanged.