MEMBERSHIP AND NEW ACCOUNT APPLICATION

New Member Application — Individual with 1 Joint Applicant

I am eligible for Community Credit Union Membership because I meet one of the following criteria:

I live or work in Essex County or within 25 miles of our home office

     in Lynn, MA.

I am directly related to a current member.

My employer is within the field of membership of Community Credit

     Union and my employer offers Direct Deposit to Community Credit

     Union.

Account Desired

Membership Savings Only — membership requires a $10 deposit into one of these accounts.

Passbook Savings (Does not apply for ATM or other electronic

     activity.

Statement Savings (Allows ATM and other electronic

      activity)

Other Accounts Desired

Checking Account (First order of 200 basic wallet checks is free)

Money Market Statement Account

Share Certificate Account

Christmas Club

Vacation Club

 

      IRA Share Certificate Account

          Traditional

          Roth

          Education

Additional Services

(Applications will be forwarded to you)
ATM Card (Primary Owner)
ATM Card (Joint Owner)
MasterMoney ATM/Debit Card (Primary Owner)
MasterMoney ATM/Debit Card (Joint Owner)
Direct Deposit
Payroll Deduction
Overdraft Protection (Checking Account only — transfers from Statement
     Savings or Money Market Statement Accounts only; authorization form
     must be completed)
Electronic Funds Transfer (Between Community Credit Union Account
      and another institution; authorization form must be completed)

Primary Owner Information

*Last Name:
*First Name:
Middle Initial:
*Social Security Number:
*Date of Birth:
Mother's Maiden Name:
*Residence Address:
(Not P.O. Box):
*City:
*State:
*Zip:
Duration (Years):
Mailing Address (If different):
Address:
City:
State:
Zip:
*Name of Employer:
*Employer Phone Number:
*Employer Address:
*City:
*State:
*Zip:
*Length of Employment:
*Home Phone:
Daytime Phone:
*E-mail Address:
	*Required

I am am not subject to backup withholding (signature card will provide detailed information.)

Joint Owner 1

I am a Community Credit Union member Yes No
*Member Number:
*Last Name:
*First Name:
Middle Initial:
	Male: Female:
*Social Security Number:
*Date of Birth:
*Relationship to Primary Owner:
Mother's Maiden Name:
*Residence Address:
(Not P.O. Box):
*City:
*State:
*Zip:
Duration (Years):
Mailing Address (If different):
Address:
City:
State:
Zip:
*Name of Employer:
*Employer Phone Number:
*Employer Address:
*City:
*State:
*Zip:
Length of Employment:
*Home Phone:
Daytime Phone:
	*Required

I am am not subject to backup withholding (signature card will provide detailed information).

All accounts are verified through a national check service agency.
Click SUBMIT to forward application.

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