Membership Application Form

Thank you for your interest in joining Jacksonville Firemen’s Credit Union. Simply by opening an account, you buy a share in Jacksonville Firemen’s Credit Union and become an owner. This ownership share gives you a voice and a vote on how YOUR Credit Union operates. As a non-profit institution, we return our profits back to our owner-members by offering better service, better rates, lower fees, and special discounts. Jacksonville Firemen’s Credit Union, like many other CUs, was founded on a simple philosophy of “people helping people.”


Please complete the membership application form below.

How did you hear about us?
(Check all that apply)
How are you eligible to join?
What county do you work for?

USA Patriot Act and Credit Bureau Disclosure  Federal law requires that we obtain, verify and record information that identifies each person who opens an account, including joint owners. With this application, we ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. Approval of your application may be delayed pending further verification of your identity. Consumer Reports by submitting an application, you authorize Jacksonville Firemen’s Credit Union to obtain a consumer credit report to evaluate your creditworthiness so that you may be considered for other Jacksonville Firemen’s Credit Union products and services. You also authorize Jacksonville Firemen’s Credit Union to access your credit reports for the purposes of evaluating the membership application and reviewing any Jacksonville Firemen’s Credit Union account you opened. You understand these reports maybe used in decisions to deny account applications, close accounts and/or restrict accounts or services.

MEMBER INFORMATION

Name*
Mailing Address*
Previous Mailing Address (If you have lived at your current address for less than 12 mos. please complete the fields below)
Date of Birth*
Identification*

OUR THANK YOU GIFT TO YOU...Becoming a member of the Jacksonville Firemen’s Credit Union, requires that you make an opening deposit of $5.00. This deposit makes you a member—and an owner—as a special THANK YOU once your membership is finalized we will make your initial deposit for you! 


Additional Member Information

I would like to add a Joint Account Owner*
I would like to add a beneficiary*

ACCOUNT OWNERSHIP

Designate the ownership of the accounts and responsibility for the services requested.*
Joint Owner Name
Joint Owner Address
2nd Joint Owner Name
2nd Joint Owner Address

BENEFICIARY ACCOUNT DESIGNATION

Beneficiary Name
Beneficiary Address
Beneficiary Date of Birth
2nd Beneficiary Name
2nd Beneficiary Address
2nd Beneficiary Date of Birth

MEMBERSHIP AGREEMENT INFORMATION

Is there someone we can thank for referring you?
Reference Name

MEMBERSHIP ACCOUNT CARD 

All of the terms, conditions, forms of account ownership, account selection and other information indicated in this Membership Application apply to all of the accounts listed unless the Credit Union is notified in writing of a change. If this application card applies to more than one account of the same type, more than one suffix will be listed for that account type. 

The account number of each of the accounts listed consists of the suffix added to the end of the Member Number listed in the “MEMBER APPLICATION AND OWNERSHIP INFORMATION” section. (For example, if your member number is 12345, your checking would be 12345-20.)

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 (or I am waiting for a number to be issued), 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 notified me that I am no longer subject to backup withholding, and

(3) I am a U.S. Citizen or other U.S. person. For federal tax purposes, you are considered a U.S. person if you are: an individual who is a U.S. citizen or U.S. resident alien; a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; an estate (other than a foreign estate); or a domestic trust (as defined in Regulations section 301.7701-7)

(4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification Instructions. Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Complete a W-2 BEN if you are not a U.S. Person. If a W-8 BEN is completed, your signature does not serve to certify this section.

Authorization: By signing below, I/we agree to the terms and conditions of the Account Agreement, Truth-in-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, 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 agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Funds Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

I have read the Account Agreement*
No File Chosen
File uploads may not work on some mobile devices.
(You can take a photo with your phone or scanner.)
No File Chosen
File uploads may not work on some mobile devices.
(You can take a photo with your phone or scanner.)

AUTHORIZATION

I/we hereby authorize Jacksonville Firemen’s Credit Union to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my/our account indicated above and the financial institution names above, hereinafter called FINANCIAL INSTITUTION, to credit and/or debit the same to such accounts. I agree to an additional $35.00 charge for each attempt returned NSF, which will be initiated as a separate transaction from the authorized payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. Law. This authority will remain in effect until I have cancelled it in writing in such time and manner as to afford Jacksonville Firemen’s Credit Union and FINANCIAL INSTITUTION a reasonable opportunity to act on it.

Use your mouse or finger to draw your signature above
Use your mouse or finger to draw your signature above
Progress
Powered by Formstack Create your own form