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
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)