Basic Membership Application

Baltimore County Employees Federal Credit Union

Thank you for taking the first step toward enjoying Credit Union member benefits! Which of the following reasons prompted your member application today. Please select one: Website search for great savings and loan services Recommended by family member Recommended by co-worker/friend Visit from our Business Development Representative Other (Please explain)

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 reduce account fraud.

Please note:

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 ENLARGED photocopy of your driver's license.
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 on personal accounts identifies each person who opens an account. In addition, on legal entity accounts, we will require identification on beneficial owners and controlling person.

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 may also ask to see your driver's license or other identifying documents.

I hereby make application for membership in and agree to conform to the By-Laws or any amendments in the Baltimore County Employees Federal Credit Union Account Agreement

Basic Membership Applicant Information
Member Account Number:
Name:
Email Address:
Driver's License Number:	State of Issue:
Social Security Number:SSN 2SSN 3	- -
Date of Birth:DOB 2DOB 3	- - (Month/Day/Year)
Spouse's Name:
Home Phone Number:Home Phone 2Home Phone 3	- -
Office Phone Number:Office Phone 2Office Phone 3Office Phone Extension	- - X
Current Mailing Address:
Second Address Line:
City:
State:
Zip Code:
Permanent Address:	(Complete only if different from above)
Employer:

Office Use Only Non Transferable
Eligibility Verified By:	____________________________________________________
Date:	____________________________________________________
Signed:	____________________________________________________ (Approved for Membership)

Joint Owner(s) Information 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. The joint owner(s) agree that the primary member may pledge all or any part of the shares in this account as collateral security for a loan or loans with this Credit Union. I hereby acknowledge receipt of a copy of this Joint Account Agreement. This Joint account is established pursuant to the Annotated Code of Maryland, Financial Institutions Article, Section 1-204, et. seq. [Unless contrary, direction is given in this account agreement upon the death of a party (parties); the funds in the multiple party account shall belong to the surviving party or parties.] Joint owner(s) (named herein), balance at death of any party payable to the survivor(s). Any joint owner has a present right to draw upon the funds in this account.
Joint Owner (1):
Social Security Number:	- -
Date of Birth:DOB 2DOB 3	- - (Month/Day/Year)
Home Phone Number:Home Phone 2Home Phone 3	- -
Current Mailing Address:
Second Address Line:
City:
State:
Zip Code:
Driver's License Number:	State of Issue:

Signature of Joint Owner (1):	X

Joint Owner (2):
Social Security Number:SSN 2SSN 3	- -
Date of Birth:DOB 2DOB 3	- - (Month/Day/Year)
Home Phone Number:Home Phone 2Home Phone 3	- -
Current Mailing Address:
Second Address Line:
City:
State:
Zip Code:
Driver's License Number:	State of Issue:

Signature of Joint Owner (2):	X

If more than one joint owner is designated herein, the Credit Union will issue, upon the death of a joint owner, one check payable to all joint owners who are then living.

Payable on Death Payee(s) [Unless contrary, direction is given in this account agreement upon the death of a party; the funds in the multiple party account shall belong to the surviving party or parties.] 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. This P.O.D. account is established pursuant to the Annotated Code of Maryland, Financial Institutions Article, Section1-204, et. seq.
Name of P.O.D. Payee (1):
Social Security Number:SSN 2SSN 3	- -
Date of Birth:DOB 2DOB 3	- - (Month/Day/Year)
Current Mailing Address:
Second Address Line:
City:
State:
Zip Code:
Name of P.O.D. Payee (2):
Social Security Number:SSN 2SSN 3	- -
Date of Birth:DOB 2DOB 3	- - (Month/Day/Year)
Current Mailing Address:
Second Address Line:
City:
State:
Zip Code:
If more than one P.O.D. payee is designated herein, the Credit Union will issue, upon the death of the party (parties), one check payable to all P.O.D. payees who are then living.

Convenience Services

The following no-cost convenience services are available to members with only a savings account. Savings ATM Card YES, I want the Savings ATM Card.
QuickTeller Audio Response YES, I want Quick Teller Phone Access at no charge. Your temporary PIN # will be the last 4 digits of your Social Security #.
You will be prompted to change your PIN the first time you access the system.
QuickTeller On-Line YES, I want home banking at no charge. (Quick Teller Audio Response PIN # is required to complete the self-enrollment process.) Instructions will be provided. My email address is:

Eligibility for Membership

I, the undersigned do solemnly declare and affirm under penalty of perjury that either

a) I am an employee, volunteer, or member of (Organization) and 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; OR

b) I am eligible for membership at Baltimore County Employees Federal Credit Union under the rules of family membership defined in the ByLaws of said Credit Union.

I am related to:
My relationship to the Primary Member stated above is that of:

X _______________________________________________________	______________
Applicant's Signature	Date

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.

STATUTORY LIEN: Pursuant to 12U.S.C. 1757, the Credit Union has a 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.

X _______________________________________________________	______________
Applicant's Signature	Date

Baltimore County Employees Federal Credit Union
23 W. Susquehanna Ave., Towson, MD 21204
410-828-4730

ABA/Routing Number: 2520-7575-7