Public Service FCU New Member Application



Share/Savings
Money Market ($5,000 minimum deposit)
Share Certificate ($1,000 minimum deposit)
Share Draft/Checking
Holiday Club
Vacation Club
Individual
Joint
Payroll deduction authorization
Mail check to credit union


Primary Account Holder







Employment





Beneficiary






TIN Certification and backup withholding information


By completing and submitting this document, I certify, under penalties of perjury

  1. that the Social Security Number (SSN)/Taxpayer Identification Number (TIN) shown is my/the correct number

  2. that I am NOT, unless designated below, 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 dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding

  3. that I am a U.S. person (including a U.S. resident alien)