Online Membership ApplicationMidState FCU offers you the opportunity to apply for credit union membership right over the Internet. Simply provide the information requested on the form below and click on "Submit Application." We have installed the proper security measures to make sure that your application will remain confidential and well-protected during transmission. If you prefer, you may also print out the application, complete it and fax it to us at (732) 541-4449.
Application For Membership Please check this box if you are currently a member and adding an account or changing account information. If this is the case, each person who is a holder of the new or changed account need only sign this Application and correct any applicable information.
III. ACCOUNT TYPESPlease select the account types you want. If approved, we will open the account(s) as one of the following: (1) in the name of the Member only if section I is completed; (2) in the name of the Member and the Joint applicant as joint tenants with right of survivorship if both sections I and II are completed; or (3) in the name of the Member as custodian for the named Minor if both sections I and II are completed and the appropriate box below is checked and completed. If you are uncertain about the type of account you want or the meaning of the terms used in this section, please read ACCOUNT TYPES.
IV. SIGNATURES AND CERTIFICATIONSBACKUP WITHHOLDING CERTIFICATIONS - Check either certification A or B below as applicable and write in the appropriate TIN/SSN. If you do not have a TIN/SSN, see the "Number Applied for" instructions on page 2.
By signing below, the undersigned apply for membership in this Credit Union; agree to its by-laws and the terms and conditions of any approved account, as amended from time to time; and authorize the Credit Union to verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency. The undersigned certify that information provided on this Application is true and correct and that the terms on the Application apply to all accounts held by the undersigned at this Credit Union. By checking the boxes below, the undersigned acknowledge receipt of the named disclosures and the terms and conditions that apply to any approved account.
THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATIONS REQUIRED TO AVOID BACKUP WITHHOLDING.
"YOU MUST BE 18 YEARS OR OLDER TO COMPLETE THIS APPLICATION"
We will begin processing this request immediately after receiving it via e-mail or fax. A form requesting your signature will be forwarded to you soon to complete the application process. Thank you.
©2016 MidState Federal Credit Union. All Rights Reserved.