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Israel Methcomm Federal Credit Union
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About
Contact
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Credit Union Membership
Loan Application
Products
Loan Payment
MemberNet Login
Home
About
Contact
Apply
Credit Union Membership
Loan Application
Products
Loan Payment
MemberNet Login
ISRAEL METHCOMM FEDERAL CREDIT UNION
Membership Application
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 (Initial)
(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 failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding (Initial)
(3) I am a U.S. person (including a U.S. resident alien), complete a W-8 BEN if you are not a U.S. person (Initial)
MEMBER APPLICATION AND OWNERSHIP INFORMATION
Member/Owner
Member No.
Street
SSN/TIN
City/State/Zip
Driver’s Lic No.
Home Phone ( )
Date of Birth
Cell Phone ( )
Employer
Work Phone
E-mail
Please select the organization you are affiliated with
Select
Israel Methodist Community Church
Pro Life Pro Family
Heartlife Ministries
Faith Based Credit Union Alliance
Membership Eligibility
Preferred Method of Communication
Text
Email
Phone
ACCOUNT OWNERSHIP
Designate the ownership of the share account
Individual
Joint with Survivorship
Joint without Survivorship
Joint Owner
SSN/TIN
Street
Driver’s Lic No.
City/State/Zip
Date of Birth
Home Phone ( )
Security Code
Work Phone ( )
E-mail
BENEFICIARY DESIGNATIONS
Payable on Death (POD) Account
Yes
No
Beneficiary/Payee
Beneficiary/Payee
Street
Street
City/State/Zip
City/State/Zip
AUTHORIZATION
By signing below, I/we certify that the information on this account card (front and back) is complete, and I/we agree to the terms and conditions of the Share Account Agreement on the reverse side and the Truth in Savings Disclosures (Rate and Fee Schedule) and to any amendment the Credit Union makes from time to time which are incorporated herein. I/we acknowledge receipt of a copy of the Agreement and Disclosures.
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
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