Member Application Form - Capital Area Federal Credit Union

Capital Area FCU Secure Member Application Form
In preparation for opening your account at the credit union, please complete the following and submit. Indicate your membership eligibility (please select one):
Membership Eligibility * Required
- I live, work, worship, or attend school in Lincoln, Kennebec, or Waldo County
- I am related to a current member (can be direct, indirect, or adoptive relationship)
Joint Application?
- Yes (Please also provide information about joint owner below)
APPLICANT
Name * Required
First Middle Initial Last
Date of Birth * Required
Month
Day
Year
Social Security # * Required
Email Address * Required
Enter Email Confirm Email Address
Home Phone Number * Required
Work Phone Number
Mobile Phone Number
Applicant Mailing Address * Required
Street Address Address Line 2 City State ZIP Code
Driver's License # * Required
Driver's License State * Required
Mother's Maiden Name * Required
Current Employer * Required
Applicant Physical Home Address (if different from Mailing)
Street Address Address Line 2 City State ZIP Code
JOINT-OWNER
Additional joint owners can be added at the credit union when we open your account
Name
First Middle Initial Last
Date of Birth
Month
Day
Year
Social Security #
Home Phone Number
Work Phone Number
Mobile Phone Number
Joint Owner Mailing Address
Street Address Address Line 2 City State ZIP Code
Driver's License #
Driver's License State
Mother's Maiden Name
Current Employer
Joint Owner Physical Home Address (if different from Mailing Address)
Street Address Address Line 2 City State ZIP Code
SERVICES
I am interested in:
- Savings/Checking/ATM-Debit Card
- Electronic Services
- Lending Products
- Other
Specify Other Interest
Notice
By submitting this Application to us, you agree and attest that your name and address shown herein is your legal name and the place of your residence; that this address is the proper address for all notice(s) required by this Application; and, you further understand that any changes in this address must be submitted to us in writing to be effective. You agree that everything stated in this Application, whether oral, written, or submitted via a Fax machine, is true and correct to the best of your knowledge. The Credit Union or its agent is authorized to investigate your credit worthiness and employment history, and to obtain a credit report. You further agree that this application shall be the Credit Union's property whether or not the Member Application is approved. You will notify us, in writing, within a reasonable time of any changes in your name or address. You understand that this on-line Application is preliminary and will be replaced by a full Membership Agreement, including disclosures, when you visit the Credit Union, sign your name(s) and your application is approved. If you request, we will provide you with the name and address of any credit bureau from which we received a credit report.

Capital Area FCU Secure Member Application Form

APPLICANT

JOINT-OWNER

SERVICES

Notice