UniStar Federal Credit Union .:. A Better Way to Bank
 
About Us: Membership Application
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To Open Your UniStar Membership Account:
Print and complete this form and return it with a check or money order (minimum $25) payable to UniStar Federal Credit Union. Your deposit opens a dividend-earning savings account, which makes you a member. For more information or assistance, please call (914) 631-1381 (inside NY state) or 1-888-UniStar (toll-free outside NY state).
UniStar Federal Credit Union Accounts Opened
Share/Savings Direct Deposit Checking
Call-24 (Telephone transactions) ATM Card
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
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 a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
________________________________________
Signature-owner		 _______________________
Date
 
Member Application and Information
_________________________________
Last Name		 ___________________
First Name		 ________
Initial
________________________________________________
Address:		 ______________
SSN/TIN
________________________________
City		 __________________
State		 ___________
Zip
________________________________
E-mail address		 _______________________________
Driver's License No.
(___)____________________________
Home Phone 		 _______________________________
Birthdate
(___)____________________________
Work Phone		 _______________________________
Mother's Maiden Name
________________________________
Employer		 _______________________________
Eligibility for Membership
Authorization
By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Rate and Fee Schedule, Funds Availability Policy Disclosure, if applicable, and to any amendments the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of copy of the Agreement and Disclosures applicable to the accounts and services requested herein. If an ATM card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Funds Transfer Agreement.

In considering this application, the Credit Union may request and use a report from outside credit reporting agencies. it may also ask a reporting agency or agencies for other such reports in connection with renewal or continuance of the service for which you are applying. If you request it, the Credit Union will tell you whether or not it asked for such a report and if it has, the name and address of the agency or agencies. I/We acknowledge notice of this disclosure under Article 25 of the New York State General Business law.
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Signature-Owner		 _______________________
Date
________________________________________
Signature-Joint Owner		 _______________________
Date
Designations
Beneficiary _______________________________
Last Name		 _______________
First Name		 ______
Initial
_______________________________________________________________
Address:
________________________________
City		 __________________
State		 ___________
Zip
Joint Owner ______________________________
Last Name		 _______________
First Name		 ______
Initial
For Credit Union Use Only    
Date of Membership____________ Opened By______ ATM Card________
Verification___________________ PIN Request_____ Check Verify______
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