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Tennessee Valley Federal Credit Union
Membership Application and Agreement

Important Information on 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, street 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.

If you open an account via mail, Internet or fax, and live more than 25 miles from a TVFCU branch, you will be required to have photocopies of identification notarized. You will also be required to submit a statement that you signed the new account paperwork in front of a Notary and include this statement with all other documents.

Because we need your signature, you may complete this form, print it and sign in the appropriate places.  Please include a check for $25 (payable to Tennessee Valley Federal Credit Union) for your opening deposit and mail to:

Tennessee Valley Federal Credit Union
P.O. Box 23967
Chattanooga, TN 37422
Attn: New Accounts

Section I

Name (Last, First, Middle)
Date / /
Account Number
(if this is an existing account)
Birth Date / /
Home Phone ( ) -
Drivers Lic State State and Number
/ Passport Number
Issue Date
Expiration Date
Social Security Number
Address
(Please include Street Address
with PO Box)
City
State
Zip

Employed By
click here if you are not sure you are eligible for membership.

Select Employee Group # (if know)
Business Phone ( ) -

Membership Eligibility

 
Section II
Joint Applicant(s)
 Minor
Additional Authorized Signatory information
Full Name
Date of Birth / /
Drivers Lic State State and Number
/ Passport Number
Issue Date  
Expiration Date  
Address
(Please include Street Address
with PO Box)
City
State
Zip  
Employed By  
Business Phone
( ) -
Home Phone ( ) -
Social Security Number
Additional Joint Applicants(s)
Minor
Additional Authorized Signatory Information
Full Name
Date of Birth / /
Drivers Lic State State and Number
/ Passport Number
Issue Date  
Expiration Date  
Address (Please include
street address with PO Box.)
City
State
Zip   
Employed By
Business Phone ( ) -
Home Phone ( ) -
Social Security Number

Account Selection

Please select the account types you want. If approved, we will open the account(s)as one of the following: (1) in the name of the Member only if section I is completed: (2) in the name of the Member and the Joint applicant as joint tenants with right of survivorship if both section I and II are completed; or (3) in the name of the Member as custodian for the named Minor if both sections I and II are completed and the appropriate box below is checked and completed. If you are unsure about the type of account you want or the meaning of the terms used in this section, please read the Terms & Condition Brochure. All Share Draft (Checking) Accounts which qualify, pay dividends monthly. See below for Accidental Death and Dismemberment Group Insurance Elections and beneficiary elections for the Power Pak, Seniors Choice, and Rewards Checking accounts.

Please check the appropriate box(es):

Checking - No Frills
 Checking - Rewards
 Checking - Seniors Choice
Share/Savings Account
 Club Account - Regular
 Money Market Account
 Christmas Club
Uniform Gift to Minor *
 First Choice ATM Card
First Choice Unlimited
ATM Service
First Choice Visa Check
(Debit) Card
Escrow

 

Designation of Transfer
on Death Beneficiary(ies): Name & Address

Name #1
Address
(Please include Street Address
with PO Box)
City, State, Zip
Name #2
Address
(Please include Street Address
with PO Box)
City, State, Zip

Overdraft Protection: This agreement provides that we may cover overdrafts by transfer, although we are under no obligation to cover overdrafts that exceed the fully paid and collected balance in your account. You authorize us to charge the following accounts(s) and in the order listed.

 Suffix order for Overdraft Protection
Overdraft not elected

*Designation of Uniform Gift to Minor:
If you check this box, you hold this account "as custodian for " under the laws of the state of Tennessee. The minor is owner of the account.

ACCIDENTAL DEATH AND DISMEMBERMENT GROUP INSURANCE ELECTIONS FOR THE SENIORS CHOICE, POWER PAK, AND REWARDS DRAFT (CHECKING) ACCOUNT
I hereby designate the following beneficiaries under the accidental and dismemberment group insurance policy for the Seniors Choice, Power Pak, and Rewards Account. Reference is made to the group policy for the terms and conditions.


1) Primary Beneficiary
Relationship
Social Security Number
2) Secondary Beneficiary
Relationship
Social Security Number

Signatures and Certificates

BACKUP WITHHOLDING CERTIFICATIONS - Mark certification A or B as applicable and write in the appropriate TIN/SSN. You must have either a TIN or Social Security Number whichever is appropriate for the account you want to open prior to the Credit Union opening the account.
TIN/SSN

A. By signing below, I certify under penalties of perjury that (1) the Taxpayer Identification Number (TIN) or Social Security Number shown on this form is my correct TIN/SSN and (2) I am not subject to backup withholding either because I am exempt from backup withholding ( and have written "exempt" after my TIN on the TIN blank), I have not been notified by the Internal Revenue Service (IRS) that I am subject to 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. (Note: If you are subject to backup withholding from the IRS and have not received notice that it has terminated, then you must strike the language certifying that you are not subject to backup withholding.)

B. NON-RESIDENT ALIENS: By signing below, I certify under penalties of perjury that (1) I am not a United States citizen, or (2) If I am an individual, I am neither a citizen or a resident of the United States.

By signing below, the undersigned hereby applies for membership at Tennessee Valley Federal Credit Union and agrees to conform to its bylaws and any amendments thereto. The undersigned further authorizes the Credit Union to verify employment and credit history by any available source including the use of a credit report by a credit reporting agency. I certify that I am eligible for membership at this Credit Union and that the information on this application is true and correct. The undersigned further understands and agrees that any signature on this application applies to all accounts under my name at this Credit Union. By checking the boxes below, I acknowledge receipt of the named disclosures and the terms and conditions that apply to each approved account.


The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholdings.

Truth in Savings Disclosure / Electronic Funds Transfer Disclosure / Funds Availability Disclosure
Fee and Dividend Disclosure

Member Signature Date

 

Joint Owner Signature Date

 

Joint Owner Signature Date

 

Joint Owner Signature Date

 

Additional Authorized Signatory (Individual Accounts Only) Date

 

CREDIT UNION USE ONLY

Application received by:

This application approved by :
Board Exec. Committee Membership Officer

Membership Officer Signature:

You can print this form, sign in the appropriate places and mail it to:

Tennessee Valley Federal Credit Union
P.O. Box 23967
Chattanooga, TN 37422
Attn: Membership Development

For current rates and more detailed information, give us a call at 634-3600 (800-634-3600 nationwide) or e-mail us at support@tvfcu.com.

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