Lansing Postal Community Credit Union Membership Application

* Required Fields





    • Part I: Ownership Information

    • Phone
      ( ) - ext




    • Employer's Phone Number
      ( ) - ext
    • Date of Birth
      / /





    • If based on a family relationship, specify type of relationship and name of family member.

    • Phone
      ( ) - ext
    • Address





    • Employer's Phone Number
      ( ) - ext
    • Date of Birth
      / /





    • If based on a family relationship, specify type of relationship and name of family member.

    • Phone
      ( ) - ext
    • Address






    • Employer's Phone Number
      ( ) - ext
    • Date of Birth
      / /





    • If based on a family relationship, specify type of relationship and name of family member.
    • Part II: TIN Certification and Backup Withholding Information
    • Under penalties of perjury, I certify that (please read carefully and check only those that apply):





    • Part III Multiple Name Account Agreement
    • Withdrawal Restrictions




    • Part IV: Beneficiary Information and Provisions
    • Upon the death of the owner, or the last surviving owner if there is more than one, the funds covered by this agreement shall become the property of the beneficiary(ies) listed below who are alive at the time. In addition, each such beneficiary shall have the power to withdraw only his or her equal share of the remaining account balance together with any accumulations on such amount. The multiple name account agreement (Part III) shall not apply to beneficiaries. No beneficiary shall have any right under any circumstances to change the terms and conditions of this agreement.




    • Part V: Acknowledgement
    • I have read these disclosures:





    • You will be asked to appear at Lansing Postal Community Credit Union with your identification and sign this form.

      Signature of Owner 1: __________________________________________________________________

      Signature of Owner 2: __________________________________________________________________

      Signature of Owner 3: __________________________________________________________________

    • Security Code
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