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Membership Application

Please provide all of the requested information. When you have completed the form, press the "Submit" button to send your application to Westerra Credit Union for processing. This data is transferred using a secure server to protect the confidentiality of your personal information.

› Click here to download this application as a pdf and bring your application to any of our convenient locations.

All fields marked with * are required.

ALL ACCOUNTS SHOULD BE

* Please choose one

PRIMARY OWNER OF ACCOUNT

* Qualifying Membership Group or Employer

* First Name * Last Name Middle Initial

* Street Address
(No PO Box) * City, State, Zip Code

Previous Address (if resided at current address for less than 2 years)

City, State, Zip Code * Home Phone Number * Work Phone Number Work Phone Ext

* Social Security Number * Date of Birth * License/ID Number * State of Issue * Mother's Maiden Name * Employer Email Address

JOINT OWNER

Relationship to Primary First Name Last Name Middle Initial

Street Address
(No PO Box) City, State, Zip Code

Previous Address (if resided at current address for less than 2 years)

City, State, Zip Code Home Phone Number Work Phone Number Work Phone Ext

Social Security Number Date of Birth License/ID Number State of Issue Mother's Maiden Name Employer Email Address

YOU ARE REQUESTING THE FOLLOWING
ACCOUNT TYPES AND CARDS

* Account Types
Please note: A Savings account with a minimum balance of $25 must be opened and maintained for membership

Savings * Holiday Savings Free Checking Interest Checking Tiered Money Market Certificate of Deposit Individual Retirement Account (IRA)

Cards and Other FREE Services Requested

VISA® Debit Card 24-Hour Phone Banking Online Banking eStatements Online Bill Payment (free when you have eStatements and a Checking Account, or $4.95 monthly if you do not use these additional services.)

PAY ON DEATH (POD) BENEFICIARIES - ACCOUNT DESIGNATIONS

All Accounts Designate Specific Account(s)

Beneficiary Full Name Social Security Number Address City, State, Zip Code

SOCIAL SECURITY NUMBER CERTIFICATION & BACKUP WITHHOLDING INFORMATION

I am subject to backup withholding I am not subject to backup withholding

By submitting, I certify, in accordance with IRS W-9 instructions provided by the Credit Union and under penalties of perjury that: (1) The Social Security Number (SSN)/Taxpayer Identification Number (TIN) shown on this application is my/the correct identification number, (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 failure to report all interest and 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 U.S. resident alien).

Please verify all of your information is completely filled out.

OTHER INFORMATION

By submitting, 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 amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge receipt of a copy of the Agreement and Disclosures applicable to the accounts and services requested herein. If an ATM or EFT service is requested and provided, I/we agree to the terms and acknowledge receipt of the Electronic Funds Transfer Agreement. I/we authorize you to check account, credit, and employment history and obtain a credit report from third parties, including credit reporting agencies, to verify eligibility for the accounts and services I/we requested. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Federal law requires us to obtain, verify and record information that identifies each person who opens an account.

Applicant(s): I agree to these terms

Please enter the code shown in the image above

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Your savings federally insured to at least $100,000 and backed by the faith and credit of the United States Government. National Credit Union Administration , a U.S. Government Agency

May 9, 2008

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Membership Application

ALL ACCOUNTS SHOULD BE

PRIMARY OWNER OF ACCOUNT

JOINT OWNER

YOU ARE REQUESTING THE FOLLOWING ACCOUNT TYPES AND CARDS

PAY ON DEATH (POD) BENEFICIARIES - ACCOUNT DESIGNATIONS

SOCIAL SECURITY NUMBER CERTIFICATION & BACKUP WITHHOLDING INFORMATION

OTHER INFORMATION

Search

Checking

Credit Cards

Savings Accounts

Convenient Services

Mortgage Loans

Loans

Sign in to Online Banking, E-Statements & Bill Pay

Advice Center

Protect Yourself: Identity Theft

YOU ARE REQUESTING THE FOLLOWING
ACCOUNT TYPES AND CARDS

Sign in to
Online Banking,
E-Statements
& Bill Pay