Multiple Services 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.

• A $5.00 minimum is required along with your application - the money will be directly deposited into your new Share Savings Account.
  
• Submit a clear photocopy of your driver's license.

Please note

• Signatures MUST be notarized on applications mailed to the Credit Union

Baltimore County Employees Federal Credit Union
23 W. Susquehanna Avenue
Towson, Maryland 21204

Important Information About Opening A New Account
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you…

When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We will also ask to see your government issued picture identification such as a driver’s license, passport, military identification or other identifying documents.

We have combined some of our most frequently requested services on this one convenient application. Simply complete and return it to us, and soon you’ll be enjoying many Credit Union benefits.

Share Savings– Your primary account required for membership. Minimum balance is only $5.00.

Club Accounts– Special accounts to help you save toward a goal—holiday expenses, vacation, auto purchase, etc. Account withdrawal limitations apply (see Rate and Fee Schedule).

Checking– No minimum balance, no monthly fees, no charge for each check written, plus overdraft protection, and the following extras:

• SmartCash VISA Check Card– Use either the credit or debit feature to pay for purchases without a fee. The funds will be deducted from your checking account. You can also withdraw money from your savings or checking account at countless no-surcharge ATMs.
  
• On-Line Services– Access your account or pay bills on-line through www.bcefcu.com. Get balances, transfer monies, and print account histories at your convenience.

Applicant's Name:
Driver's License Number / State of Issue:
Social Security Number:	- -
Date of Birth: (Month/Day/Year)	- -
Home Phone:	- -
Office Phone - Extension:	- - x
Current Mailing Address:
City:		State Maryland Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip+4:
Permanent Address:	(Complete only if different than above)
Mother's Maiden Name:

MEMBERSHIP ELIGIBILITY INFORMATION To be eligible for membership, you must either: (1) work, volunteer, or be retired from an eligible employer/agency; or (2) be an immediate relative or household member of an existing member. For field of membership groups, visit www.bcefcu.com. If I am applying for membership under family membership, I hereby certify, under penalty of perjury, that the Primary Membership information for my relative is true. If the statement is false, I understand my account will be closed. If I am applying for membership through an eligible employer/agency, I give my permission to the Organization to verify and report my status to the Baltimore County Employees Federal Credit Union, thus waiving my rights to privacy of my personnel and or membership records under Maryland Statute Article 76A.

Name of Member through whom you are eligible:		Your relationship to Member:
I am eligible as an employee, volunteer, or member of: (proof of eligibility required)
		Dept:

I hereby make application for membership in the Baltimore County Employees Federal Credit Union and agree to conform to the Federal Credit Union Act, NCUA Rules and Regulations and Credit Union policies, rules, regulations and bylaws and any amendments thereto and subscribe for at least one share. I acknowledge that membership at Baltimore County Employees Federal Credit Union comes with certain ongoing responsibilities. By signing this document, I and my joint owner(s), if any, agree to abide by the disclosed terms and conditions of all accounts or services that I/we may receive at Baltimore County Employees Federal Credit Union. These terms and conditions will be disclosed in accordance with applicable state and federal laws, and are provided in the disclosure and agreement forms to be mailed. The survivorship designation on my primary savings account applies to all other joint accounts with the same joint owner, unless specifically designated otherwise for a particular account.

STATUTORY LIEN: Pursuant to 12U.S.C. 1757, the Credit Union has the right to impress and enforce a statutory lien against your account shares, deposits and dividends, if you are in default on any loan indebtedness or other financial obligation to the Credit Union. The federal law gives the Credit Union the right to apply the balance of shares and dividends in your account(s) at the time of default to satisfy the financial obligation. The Credit Union may exercise this right without further notice to you, once you are in default. The lien applies to the financial obligations of members who are primarily, secondarily or otherwise responsible for an outstanding financial obligation to the Credit Union, including, without limitation an obligor, maker, guarantor, co-signer, endorser, surety or accommodation party. This means a lien can be impressed and enforced against the shares and dividends of a guarantor or other accommodation party.

Under penalties of perjury, I certify that the Social Security Number I have listed above is my correct taxpayer identification number and that 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. NOTE: The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. SIGNATURE MUST BE NOTARIZED IF NOT WITNESSED BY CREDIT UNION EMPLOYEE.

Signature of Member, Owner (Applicant) Executed and Sealed the date and year written		Date (MO., DAY, YEAR)
X ___________________________________________________		___________________________
	(SEAL)

Complete this area if you wish to have a JOINT OWNER or P.O.D. designee on your SHARE SAVINGS, CLUB ACCOUNTS and CHECKING ACCOUNT.

JOINT ACCOUNTS WITH SURVIVORSHIP (On the death of a party to the account, the deceased party’s ownership in the account passes to the surviving party or parties to the account.)

Joint Owner (1):
Social Security Number:	- -
Date of Birth: (Month/Day/Year)	- -
Home Phone:	- -
Office Phone:	- - x
Current Mailing Address:
City:		State Maryland Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip+4:
Driver's License Number / State of Issue:
Signature of Joint Owner (1)	X ___________________________________________________

Joint Owner (2):
Social Security Number:	- -
Date of Birth: (Month/Day/Year)	- -
Home Phone:	- -
Office Phone:	- - x
Current Mailing Address:
City:		State Maryland Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip+4:
Driver's License Number / State of Issue:
Signature of Joint Owner (2)	X ___________________________________________________

P.O.D. (Payable on Death). Upon the death of the party (parties), the funds in this account shall be payable to the below named P.O.D. Payee(s). The P.O.D. payee(s) shall not possess a right to draw upon the funds in the account during the lifetime of the party member.

Name of P.O.D. Payee (1):
Date of Birth: (Month/Day/Year)	- -
Current Mailing Address:
City:		State Maryland Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip+4:

Name of P.O.D. Payee (2):
Date of Birth: (Month/Day/Year)	- -
Current Mailing Address:
City:		State Maryland Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip+4:

Share Savings Your primary account required for membership. Minimum balance is only $5.00.