QuickTeller: On-Line Services Application   * required fields   Member Account Number *     First Name *     Middle Initial     Last Name *     Address *     Additional Address     City *     State *     Zip *     Email Address     Home Phone *     Work Phone     Social Security Number *     Mother's Maiden Name *       Additional Access Accounts   In addition to my account number listed above, I am also a joint owner on the following account(s) listed below. I understand that access to these accounts will be limited to account inquires, obtaining balances, and making transfers into those accounts through the use of QuickTeller On-Line Services offered by the Baltimore County Employees Federal Credit Union. Transferring money out of Family Member accounts is not allowed unless the Family Member has QuickTeller On-Line Service and has listed my account for access. I hereby agree to indemnify and hold harmless the Baltimore County Employees Federal Credit Union from any and all claims and demands of any nature as a result of the use of the QuickTeller On-Line services. Note: Family Member Accounts, Traditional Retirement, and Roth Retirement/Conversion Accounts are also accessible through this service.   I would like to view my: * Traditional IRA Roth IRA Roth Conversion IRA Not Applicable    YES, I WOULD LIKE ON-LINE BILL PAY access and understand there is a monthly fee for this service. Contact Members Services for additional information.     Family Member Accounts   Full Name   Account Number           Applicant Signature(s)   I/We hereby desire to subscribe to the QuickTeller On-Line Service and authorize the Baltimore County Employees Federal Credit Union to serve as my agent in transferring to and from designated accounts. I/We also understand that the Credit Union may not make certain transfers if sufficient funds are not available in said accounts. I/We furthermore agree to abide by all the rules governing the use of the QuickTeller On-Line Services, as specified in the QuickTeller On-Line Services Agreement and Disclosure incorporated herein by reference and made a part hereof. Use of the QuickTeller On-Line Service constitutes my/our understanding and acceptance of the Agreement and Disclosure in the Important Disclosures booklet. To view and print for your records, click here. The booklet is also available in print form at the Credit Union office. I have read and accept all the terms and conditions of the QuickTeller On-Line Services Agreement and Disclosures. * Signed and Sealed this date written.   Signature of Primary Member (Seal) *   Date     Signature of Joint Owner, if any (Seal)   Date       Baltimore County Employees Federal Credit Union 23 W. Susquehanna Avenue • Towson, MD 21204 • 410-828-4730 • 1-800-234-4730 • FAX 410-828-0325   For Office Use Only:   Verified By: Date: Processed By: Date: