Membership Application

Membership Application

Account #

Primary Owner Name_________________________

Social Security # (tax id #)___________________

Home Address______________________________

City_________________State_____Zip_________

Date of Birth_______________________________

Home Phone________________________________

Mother's Maiden Name________________________

E-Mail Address______________________________

Employed By (include location)__________________
___________________________________________

Work Phone__________________________________

Joint Owner Name_____________________________

Social Security # (tax id #)_____________________

Home Address________________________________

City_______________State_____Zip_____________

Date of Birth_____________Home Phone__________

Work Phone__________________________________

CERTIFICATION. - Under penalties of perjury, I certify that:

(1) The number shown on this form is my correct taxpayer identification number (or I am

waiting for a number to be issued to me), AND

(2) I am not subject to backup withholding either because I have not been notified by the

Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure
to report all interest or dividends, or the IRS has notified me that I am no longer subject to

backup withholding (does not apply to real estate transactions, mortgage interest paid, the
acquisition or abandonment of secured property, contributions to an individual retirement
account (IRA), and payments other than interest and dividends), AND

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

CERTIFICATION INSTRUCTIONS. You must cross out item (2) above if you have been notified
by the IRS that you are currently subject to backup withholding because of underreporting interest or
dividend on your tax return. I have read and understand all disclosures.

INCLUDE INITIAL $5.00 DEPOSIT AND $1.00 MEMBERSHIP FEE

I hereby make application for membership in the credit union named below, and agree to conform
to its bylaws and amendments thereof, copies of which have been made available to me, and to
subscribe for at least one (1) share. If Life Savings insurance is carried in connection with my
account, I agree, in consideration of the credit union carrying such insurance, that any designation
or change of beneficiary made by me shall only be binding upon the credit union, if I have filed with
the credit union prior to my death, such designation or change of beneficiary, in writing, signed by
me, on the form supplied by the credit union; and, in the absence of so filing a designation or change
of beneficiary, I agree on behalf of myself, my heirs, etc., to indemnify and save harmless the credit
union from all loss or damage by reason of the payment of the proceeds of such insurance to such
person as the credit union records show to be entitled thereto.

By signing this card, you authorize the credit union to obtain credit reports in connection with this
application for membership, services and/or credit, and for update, renewal or extension of the
credit received, if applicable. If you request, the credit union will tell you the name and address of
any bureau from which it received a credit report on you.

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

Primary Owner (Signature)________________________________________Date:________

Joint Owner (Signature)__________________________________________Date:________

JOINT SHARE ACCOUNT AGREEMENT (*NOT TRANSFERABLE)

INDIANA LAKES FEDERAL CREDIT UNION is hereby authorized to recognize any of the
signatures subscribed in the payment of funds or the transaction of any business for this account.
The joint owners of this account hereby agree with each other and with said credit union that all
sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said joint
owners to their credit as such joint owners with all accumulations thereon, are and shall be owned by
them jointly, with right of survivorship and be subject to the withdrawal or receipt of any of them,
and payment to any of them or the survivor or survivors shall be valid and discharge said credit
union from any liability for such payment. The joint owners also agree to the terms and conditions
of the account as established by the credit union from time to time.

Any or all of said joint owners may pledge all or any part of the shares in this account as
collateral security to a loan or loans from the credit union.

The right or authority of the credit union under this agreement shall not be changed or
terminated by said owners, or any of them except by written notice to said credit union which shall
not affect transactions theretofore made.