Credit Union Checking Application

Please fill out the form on your screen, print out and mail to the address listed below. The Credit Union requires an INK Signature for this application. We will not accept a faxed copy. This helps to reduce account fraud.

Please submit a copy of your drivers license and joint owner's drivers license (if applicable) with this application.

YES, I am a member in good standing of the Baltimore County Employees Federal Credit Union and have at least $5.00 on deposit in my Regular Share Savings Account. 

At this time, I wish to sign up for the many benefits of Credit Union Checking! Joint owner (if any) on your savings account must be the same for the checking account.


*Member Name:
*Member Account Number:
Date of Birth: / /
Mother's Maiden Name:
Social Security Number: - -
Current Mailing Address:
City: State
Zip+4:
Daytime Phone: - -
Email:
 

I understand that my email address will remain confidential in the Credit Union’s database and that I will only receive periodic on-line news and advertisements from my Credit Union.
Employer Name:
Job Position:
   
Joint Owner Name (if applicable)
Social Security Number: - -
Current Mailing Address:
City: State
Zip+4:
Date of Birth: / /
Mother's Maiden Name:
Employer Name:
Job Position:

Checking and Check Re-ordering Please print only what you would like to appear on your checks.
Name:
Address:
City: State
Zip+4:
Home Phone: - -
Driver's License Number /
State of Issue:
Indicate Choice
Wallet Style (Single) at no cost
Wallet Style (Duplicate) at no cost
Custom Check Design - contact Member Services for pricing

Yes, I would like to apply for a $300.00 Overdraft Protection/Preferred Credit Line. Service available for checking account holders only.
SmartCash Check Card Service available to checking account holders only.
  YES, I want a SmartCash Card.
  YES, I would like a card for my joint owner.
On-Line Checking Services Service available to checking account holders only.
  YES, I want QuickTeller On-Line at no charge:
    My e-mail address is:
  YES, I want QuickTeller Phone Access at no charge.
QuickTeller Pin:
Here is my QuickTeller 4-digit
Personal Identification Number

"Under penalties of perjury, I certify (1) that the number shown at the top of this form is my correct taxpayer identification number and (2) that 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 interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding."

"The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding. "

We take pride in member education and encourage you to fully understand the products and services we offer. Please take a few minutes to read the sections below that relate to your application. By signing and submitting this document for review, you agree to abide by the disclosed terms and conditions of the Credit Union Checking Account and its related services as outlined in the following disclosures in accordance with applicable state and federal laws.

Share Draft Checking Agreement
Smart Cash Check Card
QuickTeller Audio Response
QuickTeller On-Line

Signature of Member (Applicant)
Date (MO.,DAY, YEAR)
   
X ___________________________________________________
 ___________________________
   
Signature of Joint Owner (if applicable)
 Date (MO.,DAY, YEAR)
   
X ___________________________________________________
 ___________________________