Member Application and Agreement

We look forward to helping you become a member at EMCCU! To complete this application quickly and efficiently, we suggest you have the following documents available:

A copy of a valid or non-expired state-issued identification card (or driver’s license) in a JPEG or PDF format
A copy of a recent utility bill, paystub or W-2 in case your current address doesn't match your driver's license or state-issued ID

Please contact us if you have any questions!

(*) indicates a required field

Account Ownership

Designate the ownership of the accounts and responsibility for the services requested.

Account Ownership*

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Are you 18 or older?*

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If you are under the age of 18, you can still apply, but a parent or guardian over the age of 18 must also apply as a joint applicant.

How did you hear about us?*

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Please explain how you found us!*

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Disclosures*

Yes, I've read and agree to the following:

You must agree to the disclosures to proceed!

For your convenience, we will automatically send you PDFs of our disclosures after you’ve successfully submitted your application.

First Name*

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Middle Name

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Last Name*

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Physical Address (cannot be a P.O. Box)*

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City*

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State*

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Zip Code*

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Check here if your mailing address is different than above (P.O. Box is acceptable)

You must agree to the disclosures to proceed!

Mailing Address*

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City*

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State*

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Zip Code*

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Primary Phone Number*

Please enter your primary phone number

Secondary Phone Number

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E-Mail Address*

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Social Security Number/TIN*

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Are you a U.S. citizen?*

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Please provide your valid driver's license, state ID or Passport information.

Please provide two forms of valid ID. This could be your foreign passport or green card or valid government-issued identification.

ID Type*

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ID Type*

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State Issued ID Number*

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State of Issue*

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Expiration Date*

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Passport Number*

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Permanent Resident Card ID#*

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Passport Country*

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Permanent Resident Card Expiration Date*

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ID Type*

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State Issued ID Number*

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State of Issue*

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Expiration Date*

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Passport Number*

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Passport Country*

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Permanent Resident Card ID#*

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Permanent Resident Card Expiration Date*

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Please make sure you submit a photo (JPG) or scan (PDF) of your valid form of ID. Make sure your information is clearly visible. Please be sure the PDF does not exceed 5MB.

The PDF/photo must include following information: Photo, Full Legal Name, ID Number, Expiration Date, County of Origin (if applicable).

Please provide a photo of your ID*

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Please provide a photo of your ID*

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Birthdate (MM-DD-YYYY)*

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Mother's Maiden Name*

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Employer Name*

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Occupation*

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Business Phone Number*

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Retired? Please input your previous occupation

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How are you eligible for membership? Check your eligibility.*

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Please provide Member Name*

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Please provide Member Account Number (optional)

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Please provide your relationship to the Member*

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Please select eligible city*

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Please note you may be asked to provide proof of employment, school registration or church affiliation to complete the application process.

Joint Owner Information

First Name*

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Middle Name

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Last Name*

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Physical Address*

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City*

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State*

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Zip/Postal Code*

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Check here if your mailing address is different than above (P.O. Box is acceptable)

You must agree to the disclosures to proceed!

Mailing Address*

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City*

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State*

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Zip/Postal Code*

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Primary Phone Number*

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Secondary Phone Number

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E-Mail Address*

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Social Security Number*

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Are you a U.S. citizen?*

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Please provide your valid driver's license, state ID or Passport information.

Please provide two forms of valid ID. This could be your foreign passport or green card or valid government-issued identification.

ID Type*

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ID Type*

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State Issued ID Number*

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State of Issue*

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Expiration Date*

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Passport Number*

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Permanent Resident Card ID#*

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Passport Country*

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Permanent Resident Card Expiration Date*

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ID Type*

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State Issued ID Number*

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State of Issue*

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Expiration Date*

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Passport Number*

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Passport Country*

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Permanent Resident Card ID#*

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Permanent Resident Card Expiration Date*

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Please make sure you submit a photo (JPG) or scan (PDF) of your valid form of ID. Make sure your information is clearly visible. Please be sure the PDF does not exceed 5MB.

The PDF/photo must include following information: Photo, Full Legal Name, ID Number, Expiration Date, County of Origin (if applicable).

Please provide a photo of your ID*

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Please provide a photo of your ID*

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Birthdate (MM-DD-YYYY)*

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Mother's Maiden Name*

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Employer Name*

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Occupation*

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Business Phone Number*

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Retired? Please input your previous occupation

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Account Designations

Payable-On-Death Account Beneficiary Designation

In the event of my death, or if there is more than one owner of this account, in the event of death of all the owners, the owner(s) hereby designate as my/our beneficiary(ies) to receive all sums in my/our account established on this form.

Please note: If you elect multiple beneficiaries and you do not allocate percentages to each beneficiary, the funds will be split equally among the surviving beneficiaries.

Number of beneficiaries*

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First Beneficiary/POD Payee*

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Address*

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State*

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Phone Number

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Relationship*

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City*

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Zip/Postal Code*

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Birthdate (MM-DD-YYYY)*

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Percentage

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Name of 2nd Beneficiary*

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Address*

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State*

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Phone Number

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Relationship*

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City*

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Zip/Postal Code*

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Birthdate (MM-DD-YYYY)*

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Percentage

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Please note the percentages allocated to your beneficiaries must equal 100 percent in order to submit your application.

Membership Type

Please Note: There is a one-time, refundable pledge amount of $5.00 at the time of opening your account plus a $5.00 Minimum Deposit.

Account Type(s)*

Regular Share Account (Savings) ($5.00 minimum one-time initial deposit)

FREE Checking Account (no minimum deposit), also select "Checking Overdraft Protection" in next section

MasterCard Debit Card (for checking accounts only)

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Checking Overdraft Protection

Checking Account overdrafts can be covered in several different ways:

Please select:*

Yes, I want Checking Overdraft Protection transferred from Savings

No, I do not want Checking Overdraft Protection

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Courtesy Pay

Courtesy Pay is a service available on checking accounts that allows us to pay an item presented for payment against your checking account even if it causes the account to become overdrawn. The fee is $28 and this service is available to you after your account has been established for 90 days.

Please select:*

Yes, I want to opt in to Courtesy Pay

No, I do not want to opt in to Courtesy Pay

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Member Link Audio Response Account Access

24-hour access to my accounts by Member Link (Audio Response) will automatically be established unless declined by me. A Personal Identification Number (PIN) will be established by calling Member Link.

Please select:*

Yes, I want access to Member Link (Audio Response)

No, I do not want access to Member Link (Audio Response)

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Taxpayer Identification Number Certification and Backup Withholding Information

Have been notified by the IRS that you are currently subject to backup withholding because you failed to report all interest and dividends on your tax return?

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Are you a US Citizen?

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You have answered that you are NOT a US citizen. Please provide a completed IRS W-8 BEN Form.

W-8 File Upload*

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(1) The number shown on this form is my correct taxpayer information number (or I am waiting for a number to be issued), and

(2) I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding, and

(3) I am a U.S. citizen or other U.S. person (including U.S. resident alien)

(4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

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We will be unable to open an Account for You without a taxpayer identification number.

Exempt payee code (if any)

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Exemption from FATCA reporting code (if any)

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Agreement

I hereby apply for membership in El Monte Community Credit Union (EMCCU) with this application and certify that I qualify for membership based on the eligibility stated in this application. I further understand that to continue my membership in EMCCU, I must maintain an EMCCU deposit account. I authorize you to gather whatever credit, checking account and employment information you consider appropriate from time to time. I understand that this will assist you in determining my initial and ongoing eligibility for an account. I authorize you to give informaton concerning your experience with me to others. THIS INSTITUTION IS NOT FEDERALLY INSURED, AND IF THE INSTITUTION FAILS, THE FEDERAL GOVERNMENT DOES NOT GUARANTEE THAT DEPOSITORS WILL GET BACK THEIR MONEY. MEMBER SAVINGS ARE INSURED UP TO $250,000 PER ACCOUNT BY AMERICAN SHARE INSURANCE, THE NATION'S LARGEST PRIVATE DEPOSIT INSURERS.

Acknowledgement of Receipt Disclosure

By signing the Membership Application and Agreement, I acknowledge that I have received a copy of the Credit Union's Truth-in-Savings Disclosure and Electronic Services Disclosure and Agreement and that I have received a copy of the current Rate Sheet and Fee Schedule. I agree to be bound by the terms and conditions of the Credit Union's Account Agreement(s) and any amendments thereto. I understand that any new account information will be verified. Note: The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Important Information About Procedures for Opening a New Account: To help 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, 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.

Signature*

Sign Above

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Date*

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Joint Signature*

Sign Above

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Date*

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