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Membership Application

Application Requirements
Applicant Information
Tin Certification
  • Application Requirements


    Application Type

    Account Type

    All of the terms, conditions, form of account ownership, account selection and other information indicated on this card apply to all of the accounts listed unless the Credit Union is notified in writing of a change. All accounts require a share/savings account with a minimum $25.00 membership balance.

  • Applicant Information

    • All members will have to present 3 forms of id to open account (ID, SOC, credit card or birth cert) and a signature will be required to complete the enrollment

    Emergency Contact

    Beneficiary Informtion

    The owners of many accounts name payable-on-death (POD) beneficiaries for the accounts. That means that when the account owner (or the last surviving owner, in the case of a joint account) dies, the POD beneficiary can simply claim the money from the Credit Union. The deceased person's will does not come into play, and there's no need for any probate court involvement, either.

    POD designations are widely used because they're simple both for the person who sets them up and the beneficiaries who inherit. Please indicate below if you would like to include a beneficiary at this time.

    • Would you like to designate a beneficiary? *

    Beneficiary #1

    Beneficiary #2

    Beneficiary #3

    Beneficiary #4

    Beneficiary #5

    Joint Applicant

    • All members will have to present 3 forms of id to open account (ID, SOC, credit card or birth cert) and a signature will be required to complete the enrollment

  • 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 has 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 301.77701.7).
    4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

    Certification Instructions.Complete a W-8 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 Agreement

    I/We agree to the terms and conditions of the Membership and 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 Fund 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.

    To complete the account opening process, you must stop by a La Porte Community FCU location with your government-issued photo ID.

    As part of the account opening process, La Porte Community FCU will obtain information about you from a consumer reporting agency. Based on that information, you may or may not be approved to open the account. I authorize La Porte Community FCU to access consumer reports for me and any joint applicants in order to process this application.