Section 5 — JOINT SHARE ACCOUNT AGREEMENT, if applicable
FASNY FCU is hereby authorized to recognize any of the signatures subscribed on this application in the payment of funds or the
transaction of any business for this account. The joint owners of this Account hereby agree with each other and with FASNY FCU that
all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all said joint owners to their credit as such
joint owners with all accumulations thereon, are and shall be owned by them jointly, with right of survivorship and be subject to the
withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge FASNY FCU
from any liability for such payment. Any or all said joint owners may pledge all or any part of the share in this as collateral security
to a loan or loans. The right or authority of FASNY FCU under this agreement shall not be changed or terminated by said owners, or
any of them except by written notice to FASNY FCU which shall not affect transactions therefore made. We reserve the right to require
written consent of all owners for any change to or termination of an account.
Section 6 — SHARE DRAFT (CHECKING) ACCOUNT AGREEMENT, if applicable
Membership
Application
FASNY FCU is authorized to pay items signed by me/us and to charge all such payments against the shares in this account, as
outlined in our Disclosure Statement. It is further agreed that:
a. FASNY FCU is under no obligation to pay an item that exceeds the fully paid and collected share balance in this account; FASNY
FCU may, however, pay such items and transfer shares to this account in the amount of the resulting overdraft, from any
designated overdraft sources or any other share account from which any of the undersigned is then able to withdraw shares,
excluding certificates. See Fee Schedule.
b. You are able to designate an alternate source of transfer funds. If you have applied under separate agreement and have been approved for an Overdraft Line of Credit, FASNY FCU may first advance funds from your Overdraft Line of Credit and apply the funds
to any overdrafts. If any amount of available credit is insufficient to pay the overdraft, transfers will be made from the accounts
listed above.
c. FASNY FCU reserves the right to close share draft (checking) accounts with zero balances and no activity for three (3) consecutive months.
• Membership in FASNY FCU requires the opening of a savings account with a minimum $5 deposit
• A minimum opening deposit of $50 is required to also open a checking account
• Photocopy of current driver’s license or valid photo ID is required
Section 1 — PRIMARY ACCOUNT HOLDER INFORMATION
First Name
Middle Initial
Last Name
Social Security Number
Street Address (No P.O. Boxes)
City
State
Zip
Mailing Address (if different)
City
State
Zip
Home Phone Number
Date of Birth
Cell Phone Number
Mother’s Maiden Name
E-mail Address
FASNY/NVFC Member #
 Female
Employer
Occupation
Middle Initial
Last Name
What this means for you: When you open an account, we will ask for your name, address, telephone number, date of birth, social security number or EIN, employer, driver’s license number or picture ID. We may also ask to see a copy of these identifying documents.
Under penalty of perjury, I certify that (1) the number shown on this form is the correct taxpayer identification number, (2) I am not
subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interests or dividends, or the Internal Revenue Service (IRS) has notified me that I am no longer subject to backup
withholding, and (3) I am a U.S. person (including a nonresident alien). The IRS does not require my consent to any provisions of
this document other than the certification required to avoid backup withholding.
Section 9 — APPLICATION CERTIFICATION AND SIGNATURE(S)
Section 2 — JOINT ACCOUNT HOLDER INFORMATION
First Name
Important Information About Procedures for Opening a New Account: 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. Confidentiality of the information maintained by FASNY FCU will be protected as required under our
Privacy Policy.
Section 8 — CERTIFICATION AS TO TAXPAYER ID (SS) NUMBER & BACKUP WITHHOLDING
Work Phone Number
Gender
…… Male
Section 7 — USA PATRIOT ACT
Social Security Number
I hereby make application for membership in FASNY FCU and agree to conform to its bylaws and amendments, Terms and
Disclosures and Electronic Funds Transfer regulations thereof. Everything I have stated in this application is correct to the best of
my knowledge. FASNY FCU may periodically request and use reports from outside consumer reporting agencies and may answer
questions about FASNY FCU’s experience with me. If I request it, FASNY FCU will tell me/us whether or not such a report was
requested, and if so, the name and address of the consumer reporting agency or agencies.
Street Address (No P.O. Boxes)
City
State
Zip
Section 10 — eSTATEMENTS
Mailing Address (if different)
City
State
Zip
By opting for eStatements in Section 3 above, I agree to accept my periodic account statements online (eStatements) and to not receive paper
statements by mail. I will receive an email from FASNY FCU advising me that my eStatement is ready for reviewing. My eStatements will include
the periodic account and transaction activity for my deposit and loan accounts, electronic funds transfer services, and notice of billing error rights.
I may access eStatements by logging into the internet banking service on the FASNY FCU website www.fasnycu.com.
Home Phone Number
Date of Birth
Cell Phone Number
Mother’s Maiden Name
Work Phone Number
Gender
……
E-mail Address
FASNY/NVFC Member #
Male
Please note: You have the right to request periodic statements in paper form, and you may withdraw your consent to receive online statements
at any time by contacting the credit union. There are no fees or account restrictions for requesting to withdraw your consent for eStatements and
going back to paper statements.
 Female
Employer
Occupation
How did you hear about FASNY FCU?
…… Advertisement: Where? _________________________________
……
……
……
Section 3 — ACCOUNTS & SERVICES
Accounts
Amount of Opening Deposit
……
Regular Shares*
$___________________
……
Share Draft
$___________________
……
eStatements†
……
Christmas Club
$___________________
……
ATM/Debit Card**
……
Vacation Club
$___________________
……
Online Bill Pay**†
……
Tax Saver Club
$___________________
* required
Fellow Firefighter: What department? ______________________
Friend, relative, co-worker. Name: _________________________
Other (please specify): __________________________________
Services
† valid
Applicant’s Signature _______________________________________________ Date ____________
Co-Applicant’s Signature ____________________________________________ Date ____________
email is required **checking account required
Section 4 — MEMBER COMMUNICATIONS
By checking the below box, I am indicating my preference to have FASNY FCU contact me by the following method(s) regarding the
status of my/our account status or activity.
FOR CREDIT UNION USE ONLY
Member Number
Date Account(s) Opened
Added to Internet Teller
Please note: In the event we suspect fraudulent activity on your account, we may attempt to reach you by phone to verify information.
However, we will never ask you for secure information, like your PIN or password, in any outbound communication.
____
__/__/____
__/__/____
Primary Member ATM/Debit Card Number
Card Added to FedComp
Checks Ordered
My preferred method of communication is:
c Home Phone c Cell Phone c Work Phone c E-Mail c Mail
________________
__/__/____
__/__/____
Joint Owner ATM/Debit Card Number
Card Added to FedComp
Enrolled in Bill Pay
________________
__/__/____
__/__/____