Membership
Membership
MembershipApplication
Application
Application
IMPORTANT INFORMATION ABOUT PROCEDURES
IMPORTANT
IMPORTANT
INFORMATION
ABOUT
ABOUT
PROCEDURES
PROCEDURES
FORINFORMATION
OPENING
A NEW
ACCOUNT
FOR
FOROPENING
OPENINGAANEW
NEWACCOUNT
ACCOUNT
help the government fight the funding of terrorism and money laundering
To
ToTohelp
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thegovernment
government
fight
fight
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funding
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and
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law requires
all
financial
institutions
to obtain,
verify
and
record
activities,
activities,
Federal
Federal
law
law
requires
requires
allall
financial
financial
institutions
institutions
to to
obtain,
obtain,
verify
verify
and
record
record
information
that
identifies
each person
who opens
an account.
What
thisand
means
to
information
information
that
identifies
identifies
each
each
person
person
who
who
opens
anan
account.
account.
What
What
this
this
means
toto
you:
When that
you
open
an account,
we ask
foropens
your
name,
address,
date
ofmeans
birth,
and
you:
you:
When
When
you
you
open
open
an
account,
account,
wewe
ask
forfor
your
your
name,
name,
address,
address,
date
of
birth,
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and
and
other
information
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will
allow
us
toask
identify
you.
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also date
ask
toof
see
your
other
other
information
information
that
that
will
will
allow
allow
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us
to to
identify
identify
you.
you.
We
We
may
may
also
also
ask
ask
to to
see
see
your
your
driver’s
license
or other
identifying
We
may
also
contact
your
employer
driver’s
driver’s
license
or or
other
other
identifying
identifying
documents.
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We
may
may
also
also
contact
contact
your
your
employer
employer
to
verifylicense
the
information
provided
bydocuments.
you.
to to
verify
verify
thethe
information
information
provided
provided
byby
you.
you.
Simply complete this application (please print) and send it to the credit union.
Simply
Simply
complete
complete
this
this
application
application
(please
(please
print)
and
and
send
send
it(Savings)
to
it to
thethe
credit
credit
union.
union.
Include
$25
which
will
be deposited
into print)
your
new
Share
Account.
Include
Include
$25
$25
which
which
willwill
bebe
deposited
deposited
into
into
your
your
new
new
Share
Share
(Savings)
(Savings)
Account.
Account.
Account #
Account
Account
##
Joint
Joint
JointShare
Share
ShareAccount
Account
AccountAgreement
Agreement
Agreement(Not
(Not
(NotTransferable)
Transferable)
Transferable)
UGI Employees Federal Credit Union is hereby authorized to recognize any of the signatures subscribed hereto in
the
payment
ofFederal
funds
orCredit
transaction
of is
any
for this to
account.
Theany
joint
of this account
hereby
agree
ClearChoice
Union
UGIUGI
Employees
Employees
Federal
Federal
Credit
Credit
Union
Union
hereby
isbusiness
hereby
authorized
authorized
recognize
to recognize
any
ofowners
the
of the
signatures
signatures
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subscribed
hereto
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in in
with
each
other
and
said
Credit
Union
all
sums
now
paid
in account.
on shares
or
hereto
or hereafter
paid
inhereby
onhereby
shares
by
thethe
payment
payment
of funds
of funds
or transaction
or
transaction
ofthat
any
of any
business
business
for for
this
this
account.
TheThe
joint
joint
owners
owners
of this
of this
account
account
agree
agree
any
or
all
of said
joint
owners
toUnion
their
credit
joint
owners
with
allor
accumulations
thereon,
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and
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each
each
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and
and
said
said
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Credit
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that
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all as
sums
all such
sums
now
now
paid
paid
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in on
shares
shares
hereto
or hereto
or hereafter
or hereafter
paid
paid
in on
in on
shares
shares
by by
owned
by all
them
jointly,
with
right
of their
survivorship
and
bejoint
subject
to
the
or receipt
of any
of
and
anyany
or all
or
of
said
of said
joint
joint
owners
owners
to their
to
credit
credit
as as
such
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owners
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with
with
allwithdrawal
all
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andand
for
each payment.
The
joint
also
agree
to the
terms
and
conditions
of the
account
asUnion
established
by liability
the
payment
payment
to any
to any
of them
of
them
or the
orowners
the
survivor
survivor
or survivors
or survivors
shall
shall
be be
valid
valid
and
and
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discharge
said
said
Credit
Credit
Union
from
from
anyany
liability
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from time
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time.
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may
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all or any
of
the
shares
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this account
asthe
for for
each
each
payment.
payment.
TheThe
joint
owners
owners
also
agree
agree
toowners
the
to the
terms
terms
and
and
conditions
conditions
ofpart
the
of the
account
account
as as
established
by by
the
collateral
security
totime
atoloan
orAny
loans
from
this
credit
union.
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right
the
credit
union
under
this
credit
credit
union
union
from
from
time
time.
to time.
Any
or all
or
said
all said
joint
joint
owners
owners
may
may
pledge
pledge
all or
or
allauthority
any
or any
partpart
ofofthe
of
the
shares
shares
in
this
in this
account
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as as
agreement
shall
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or loans
terminated
said
owners,
orThe
any
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credit
credit
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under
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union
whichshall
shall
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transactions
theretofore
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agreement
agreement
shall
not
not
beaffect
be
changed
changed
or terminated
or terminated
by said
by said
owners,
owners,
or any
or any
of them
of them
except
except
by written
by written
notice
notice
to said
to said
credit
credit
union
union
which
which
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affect
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transactions
transactions
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theretofore
made.
made.
Joint Owner #1’s First Name, M.I., Last Name
Joint
Joint
Owner
Owner
#1’s
#1’s
First
First
Name,
Name,
M.I.,
M.I.,
Last
Last
Name
Name
Social Security # or Tax I.D. #
Social
Social
Security
Security
# or
# Tax
or Tax
I.D.I.D.
# #
Mailing Address (if different from primary applicant’s)
Mailing
Mailing
Address
Address
(if different
(if different
from
from
primary
primary
applicant’s)
applicant’s)
City
City
City
Zip
ZipZip
Physical Residence Address (if different than address given above)
Physical
Physical
Residence
Residence
Address
Address
(if different
(if different
than
than
address
address
given
given
above)
above)
Date of Birth
Date
Date
of Birth
of Birth
Home Phone #
Home
Home
Phone
Phone
# #
E-mail Address
E-mail
E-mail
Address
Address
Employer (Name, City, State)
Employer
Employer
(Name,
(Name,
City,
City,
State)
State)
Work Phone #
Work
Work
Phone
Phone
# #
Employer’s Phone #
Employer’s
Employer’s
Phone
Phone
# #
Relationship to Primary Applicant
Relationship
Relationship
to Primary
to Primary
Applicant
Applicant
Applicant’s First Name, M.I., Last Name
Applicant’s
Applicant’s
First
First
Name,
Name,
M.I.,
M.I.,
Last
Last
Name
Name
Joint Owner #2’s First Name, M.I., Last Name
Joint
Joint
Owner
Owner
#2’s
#2’s
First
First
Name,
Name,
M.I.,
M.I.,
Last
Last
Name
Name
Social Security # or Tax I.D. #
Social
Social
Security
Security
# or
# or
Tax
Tax
I.D.
I.D.
##
Social Security # or Tax I.D. #
Social
Social
Security
Security
# or
# Tax
or Tax
I.D.I.D.
# #
Mailing Address (if different from primary applicant’s)
Mailing
Mailing
Address
Address
(if different
(if different
from
from
primary
primary
applicant’s)
applicant’s)
Mailing Address
Mailing
Mailing
Address
Address
City
City
City
State
State
State
Zip
ZipZip
Physical Residence Address (if different than address given above)
Physical
Physical
Residence
Residence
Address
Address
(if (if
different
different
than
than
address
address
given
given
above)
above)
Date of Birth
Date
Date
of of
Birth
Birth
State
State
State
City
City
City
Date of Birth
Date
Date
of Birth
of Birth
Home Phone #
Home
Home
Phone
Phone
# #
E-mail Address
E-mail
E-mail
Address
Address
Work Phone #
Work
Work
Phone
Phone
# #
Employer’s Phone #
Employer’s
Employer’s
Phone
Phone
# #
Relationship to Primary Applicant
Relationship
Relationship
to Primary
to Primary
Applicant
Applicant
E-mail Address
E-mail
E-mail
Address
Address
Zip
ZipZip
Physical Residence Address (if different than address given above)
Physical
Physical
Residence
Residence
Address
Address
(if different
(if different
than
than
address
address
given
given
above)
above)
Employer (Name, City, State)
Employer
Employer
(Name,
(Name,
City,
City,
State)
State)
Home Phone #
Home
Home
Phone
Phone
##
State
State
State
Signature(s)
Signature(s)
Signature(s)
We apply
applyfor
formembership
membership
in UGI EFCU
and
agree
in the
theAgreements
Agreements
We
in ClearChoice
FCU
and
agreetotothe
theconditions
conditions stated
stated in
We
We
apply
apply
forfor
membership
membership
in
UGI
in
UGI
EFCU
EFCU
and
and
agree
agree
to
thethe
conditions
conditions
stated
stated
in the
in the
Agreements
Agreements
and
Disclosures,
the
bylaws,
rules
and
regulations
ofcredit
credit
union.
and
Disclosures,
the
bylaws,
rules
and
regulations
of
theto
union.
and
and
Disclosures,
Disclosures,
thethe
bylaws,
bylaws,
rules
rules
and
and
regulations
regulations
of of
thethe
credit
credit
union.
union.
Cell Phone #
Cell
Cell
Phone
Phone
##
Work Phone #
Work
Work
Phone
Phone
##
Applicant’s Signature
Applicant’s
Applicant’s
Signature
Signature
Joint Owner #1’s Signature
Joint
Joint
Owner
Owner
#1’s
#1’s
Signature
Signature
Joint Owner #2’s Signature
Joint
Joint
Owner
Owner
#2’s
#2’s
Signature
Signature
Employer (Name, City, State)
Employer
Employer
(Name,
(Name,
City,
City,
State)
State)
For
Credit
For
For
Credit
CreditUnion
Union
UnionUse
Use
UseOnly
Only
Only
Documentary Verification
Employer’s Phone #
Employer’s
Employer’s
Phone
Phone
##
Membership Eligibility (check one)
Membership
MembershipEligibility
Eligibility
(check
(checkone)
one)
Employment: T
Family Member: T
Employment:
Employment:
TT
Family
Family
Member:
Member:
TT
List name and relationship of member recommending you
List
List
name
name
and
and
relationship
relationship
of of
member
member
recommending
recommending
you
you
W-9
W-9
W-9FORM
FORM
FORM-- -INTERNAL
INTERNAL
INTERNALREVENUE
REVENUE
REVENUESERVICE
SERVICE
SERVICE
TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION
TIN
TIN
CERTIFICATION
CERTIFICATION
AND
AND
BACKUP
BACKUP
WITHHOLDING
WITHHOLDING
INFORMATION
INFORMATION
Under penalties of perjury, I certify that: (1) The number shown on this form is my
Under
Under
penalties
penalties
of of
perjury,
perjury,
Inumber,
certify
I certify
that:
that:
(1)
The
The
number
number
shown
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this
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Any financial service provided by UGI EFCU may be used for any transaction permitted by law.
Any
Any
financial
financial
service
provided
provided
by
by
UGI
UGI
EFCU
EFCU
may
may
be
be
used
used
forfor
any
transaction
transaction
permitted
permitted
byby
by
law.
law.
You
agree
thatservice
illegal
use
of any
service
will
bebe
deemed
an
action
of default
or breach
Any
financial
service
provided
byfinancial
ClearChoice
FCU
may
used
forany
any
transaction
permitted
law.
You
You
agree
agree
that
that
illegal
illegal
use
of
any
any
financial
financial
service
will
will
be
be
deemed
deemed
anan
action
action
ofcause
of
default
default
or or
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breach
of
contract.
Use
of
anyuse
financial
service
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manner
not
permitted
law
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that
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You
agree
that
illegal
use
of of
any
financial
will
be
deemed
an by
action
of
default
or breach
of
conof
contract.
of
contract.
Use
Use
of
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of
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financial
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in
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in
manner
a
manner
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not
permitted
permitted
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by
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law
may
may
cause
cause
that
that
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service
or related
services
to be terminated
UGI EFCU’s
discretion.
should
illegal
tract. Use
of any financialservice
in aatmanner
not permitted
by lawYou
mayfurther
cause agree,
that service
or related
or or
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toany
to
bebe
terminated
terminated
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UGI
UGI
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discretion.
You
You
further
further
agree,
agree,
should
should
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illegal
use
occur,
toservices
waive
right
to sueatUGI
EFCU
fordiscretion.
such
illegal
use
or
any
activity
directly
or
services
to
be
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at
ClearChoice
FCU's
discretion.
You
further
agree,
should
illegal
use
occur,
use
use
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occur,
to
to
waive
waive
any
any
right
right
to
to
sue
sue
UGI
UGI
EFCU
EFCU
for
for
such
such
illegal
illegal
use
use
or
or
any
any
activity
activity
directly
directly
or or
indirectly
related
to
it.
Additionally,
you
agree
to
indemnify
and
hold
UGI
EFCU
harmless
from
to waive any right to sue ClearChoice FCU for such illegal use or any activity directly or indirectly
indirectly
indirectly
tolegal
to
it. Additionally,
it.action
Additionally,
you
agree
agree
toand
to
indemnify
and
and
hold
hold
UGI
UGI
EFCU
EFCU
harmless
from
from
any
suits related
or
other
or liability,
directly
or indemnify
indirectly,
resulting
from
suchharmless
illegal
use.
related
to related
it.
Additionally,
you agree
toyou
indemnify
hold
ClearChoice
FCU
harmless
from
any
suits
any
any
suits
suits
or
or
other
other
legal
legal
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action
or
or
liability,
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directly
directly
or
or
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indirectly,
resulting
resulting
from
from
such
such
illegal
illegal
use.
use.
or other legal action or liability, directly or indirectly, resulting from such illegal use.
Signature
Signature
Signature
I apply for membership in UGI EFCU and agree to the conditions stated in the Agree-
R Employer ID Card #
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Employer
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R State ID Card #
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Date
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Date
Date
Date
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Date
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(or) Non-Documentary Verification
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Signature:
Signature:
ClearChoiceFCU.org
Date
Date
Date
Date
Date
Date
ClearChoice