| Local 20 IBEW FCU Checking/Savings Account Application Please print this form, fill it out and fax to 214-363-5836 | 
| Account Information | |
| Will there be a co-applicant on this application?  Yes  No | |
| I am interested in:  Checking Account Type of Checking Account: ____________________________________________ Initial Deposit Amount: $_______________________________________________ Source of Deposit:  Transfer from a current account.   Account Number:  _____________________  I will transfer funds from another institution.  I will mail a check/money order.  Other.   (please describe)  _________________________________________  Savings Account Type of Savings Account: _____________________________________________ Initial Deposit Amount: $_______________________________________________ Source of Deposit:  Transfer from a current account.   Account Number:  _____________________  I will transfer funds from another institution.  I will mail a check/money order.  Other.   (please describe)  _________________________________________  Other Account Description: ________________________________________________________ Initial Deposit Amount: $_______________________________________________ Source of Deposit:  Transfer from a current account.   Account Number:  _____________________  I will transfer funds from another institution.  I will mail a check/money order.  Other.   (please describe)  _________________________________________ | |
| I am also interested in:  ATM Card  ATM and Check/Debit Card  Credit Card  Direct Deposit  Other   (please describe)  ______________________________________________ | 
| Primary Applicant | |
| Last Name: | Member Number: | 
| First Name: | Middle Name: | 
| Social Security Number (TIN): | Date of Birth: | 
| Home Phone Number: | Work Phone Number: | 
| Other Phone Number: | Email Address: | 
| Drivers License #: | Drivers License State: | 
| Mother's Maiden Name: | Present Employer Name: | 
| Home Address | |
| Address 1: | |
| Address 2: | |
| City: | State, Zip: | 
| Co-Applicant | |
| Last Name: | Member Number: | 
| First Name: | Middle Name: | 
| Social Security Number (TIN): | Date of Birth: | 
| Home Phone Number: | Work Phone Number: | 
| Other Phone Number: | Email Address: | 
| Drivers License #: | Drivers License State: | 
| Mother's Maiden Name: | Present Employer Name: | 
| Home Address | |
| Address 1: | |
| Address 2: | |
| City: | State, Zip: | 
| Additional Information | |
| How would you prefer to be contacted?  Home Phone  Work Phone  Other Phone  Email Address  Other: | |
| Special Instructions/Comments: | 
| Signatures | |
| Primary Applicant Signature: | Date: | 
| Co-Applicant Signature: | Date: | 
