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.