Harborstone Credit Union
Membership Application Request

Thank you for choosing Harborstone Credit Union. The first step to becoming a member of Harborstone Credit Union is to fill out this application and submit it to us. After we have received and reviewed the information from this application, you will receive additional information on the types of accounts Harborstone Credit Union has to offer, along with instructions on the final steps to take in order to complete the membership application process.

Identity Verification Notice
On October 26, 2001, President Bush signed into law the USA Patriot Act. The purpose of this law is to help protect you, your family and our country from terrorism by preventing terrorist financing. We want you to know that section 326 of this Act requires our credit union to verify the identity of all new credit union members. We must also verify the identity of members and nonmembers added as signatories to and have access to new or existing deposit accounts and loans. We must also retain copies of documents used to verify your identity.

If you are an existing member who joined the credit union before the USA Patriot Act rules became effective we may also need to verify and retain copies of any documents used to verify your identity when you request a new deposit account, apply for a loan or are added as a signatory to a new or existing deposit or loan account.

We ask for your understanding as we work to support these efforts to maintain the security of your funds and our country. Please speak with a credit union staff member if you have any questions or concerns about our identification policies.

Copyright 2002 CUNA Mutual Group

Note: The information you enter will be handled in a confidential manner.

Primary Member Information


Name

SSN#

- -

Street Address

Apt.

City, State, Zip

Click here if your street address is different than your mailing address and then fill out the fields below.

Mailing Address

City, State, Zip

Home Phone

E-Mail Address

Work Phone

Ext.

Date of Birth

/ /
 
Joint Owner Information


Name

SSN#

- -
Click here if the address and home phone are the same as listed above.

Street Address

Apt.

City, State, Zip

Home Phone

E-Mail Address

Work Phone

Ext.

Date of Birth

/ /

 
Membership Qualifications

Please select the community in which you either live or work
OR
If you do not live or work in the areas listed above

 
Optional Information To Help Us Serve You Better
I currently Rent Own my home

My occupation is

My income range is

Under $20,000

$20,000 - $29,999

$30,000 - $39,999

$40,000 - $49,999

$50,000 - $59,999

$60,000 - $69,999

$70,000 - $79,999

$80,000 - $89,999

$90,000 - $99,999

Over $100,000

 
Education level last completed

High School/GED

Some College

Associate's Degree

Bachelor's Degree

Master's Degree

Doctorate Degree

Marital Status Single Married Separated Divorced Widowed

Number of children under the age of 18 living with me at this address

Mother's Maiden Name

Drivers License Number

Drivers License State

We want to be your full service financial provider. Are there any other products or services that you would be interested in?

First Mortgages

Second Mortgages

Vehicle Loans

VISA Credit Cards

Personal Loans

Savings Clubs

Checking Accounts

Certificates

Money Market Account

IRAs

Other:

 
Do you anticipate performing any of the following services in the future?

Purchasing Money Orders

Purchasing Travelers Checks

Sending Western Unions

Large Cash Deposit or Withdrawals

Conducting Wire Transfers

Check Cashing Services

 
Do you currently have an automobile loan or mortgage at another financial institution?
Yes No

If so, would you like a member service representative to show you how you may be able to save money by transferring these loans to Harborstone Credit Union?
Yes No

Do you have any high interest credit cards or department store cards?
Yes No

If so, would you like a member service representative to contact you to discuss how transferring your balance to Harborstone Credit Union may allow you to save money each month?
Yes No

By submitting this form, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Rate and Fee schedule(s), and to any amendment Harborstone Credit Union may make from time to time which are incorporated therein. I/we authorize Harborstone Credit Union to check my credit, employment history, obtain a credit report, and to answer questions about its credit experience with me. As primary member, I understand and agree that if other persons are listed under "joint members" they will have the same rights to withdraw funds that I do. All terms governing account holders govern them and me.