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  3. Membership Application and Account Card

Membership Application and Account Card

Existing members can establish a new membership or update an existing one by mail.

Instructions

  1. Read and accept the two disclosures provided below
  2. Fully complete the form that appears after you accept the disclosures
  3. Print the form
  4. Sign the form
  5. Photocopy your valid U.S. driver's license or State-issued ID card
  6. Mail the photocopy and printed form to Star One Credit Union, P.O. Box 3643, Sunnyvale CA 94088-3643

To avoid processing delays, and to collect your most current information, the Member Application and Account Card must be completed in its entirety.

Membership Application and Account Card

Important information about opening a new account

To help our government fight the funding of terrorism and money-laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person when opening a new account. What does this mean for you? When you open an account, we will ask your name, address, birth date, and other information that will help us to identify you. We may also ask to see some type of positive identification.

Accept the Two Following Disclosures

Please carefully read the following electronic communications disclosures and acknowledge your consent by checking the corresponding "I Agree" boxes:

Membership and Account Agreement

Please carefully read the Membership and Account Agreement disclosure, then acknowledge your consent by clicking the "I Agree" box below.

Checking and Savings Rate and Fee Schedule

Please carefully read the Checking and Savings Rate and Fee Schedule disclosure, then acknowledge your consent by clicking the "I Agree" box below.

Eligibility Information

Membership Number:
Purpose of Application:
Establish new membership
Update existing membership
Reason for update:
If relative of member:
Relative's member number:
Relationship to relative:
Purpose of account: Personal activity
Source of funds:
I hereby apply for membership in Star One Credit Union. I am eligible because:

Document viewed to verify membership eligibility:

Designate account ownership

Check one of the following to designate the ownership of the accounts and responsibility for the services requested:

Individual
Joint with Right of Survivorship
Pay on Death
UTMA (under the Uniform Transfers to Minors Act)
Minor
Conservatorship/Guardianship
Estate Account (Name of Estate):
Sole Proprietorship (Name of Proprietorship):
Court-Ordered Blocked Account. Check this box if this is a court-ordered blocked account. Documents have been issued by a court of law governing the funds on deposit in this account.
This is an irrevocable trust account
This is a revocable trust account

Trust Agreement and Certification of Trust

Each Trustor/Trustee warrants and agrees as follows:

  1. A valid living Trust has been established under applicable law and currently exists.
  2. At least one Trustor of a Revocable Trust must be a member of the Credit Union. All Trustors or all named beneficiaries of an Irrevocable Trust must be members of the Credit Union.
  3. Trustee agrees to notify the Credit Union in writing of any change in Trustees for the Trust.
  4. The Credit Union is under no obligation to administer the Trust, act as a Trustee, or inquire as to the powers and duties of any Trustee. The Credit Union may, however, withhold payment of funds to any party until satisfactory evidence of authority is produced.
  5. The Credit Union may rely on the authority of any Trustee until it receives written notice of revocation of the Trust or termination of Trustee's authority. The Credit Union may release funds or rely on the direction of any one Trustee acting alone unless the Credit Union agrees in writing that consent of more than one Trustee is required.
  6. The Trust and the Trustees will indemnify and hold the Credit Union harmless from any claim, damage, or loss arising from the unauthorized acts of any Trustee or former Trustee unless a Successor Trustee notifies the Credit Union in writing prior to the unauthorized acts.
  7. All accounts held in the name of the Trust will be governed by this Agreement, the Membership Application and Account Card, and by the terms of the Credit Union's Membership and Account Agreement and Disclosures as amended from time to time. Trustee has received a copy of the Agreement and Disclosures pertaining to the account(s) requested.
  8. If this is a Revocable Trust and the Credit Union receives any garnishment, levy, or other form of execution against the Trustor(s), or if the Trustor(s) owes money to the Credit Union, the Credit Union may treat all accounts held by or on behalf of the Trust as if they were held by the Trustor(s) individually.
  9. THIS AGREEMENT AFFECTS YOUR LEGAL RIGHTS. IF YOU DESIRE ASSISTANCE OR ADVICE CONCERNING THIS AGREEMENT, YOU SHOULD SEEK THE ADVICE OF AN ATTORNEY OR OTHER PROFESSIONAL PERSON. THE CREDIT UNION CANNOT GIVE LEGAL ADVICE REGARDING EITHER THIS AGREEMENT OR THE TRUST.

Member/Owner/Minor Information (includes UTMA minor)

Member/Owner/Minor Name:
SSN/TIN:
U.S. ID Type:
ID Number:
ID Issuing State:
ID Issue Date:
ID Exp. Date:
Birth Date:
Residential Address (no P.O. boxes):
Residential Address, line 2:
City/State/Zip:
Mailing Address:
City/State/Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:
Employer:
Password Identifier:
Occupation:

Election of savings or deposit account types and services

Account Type, Account Suffix and Account Services

Money Market Savings # 01
Checking # Designated overdraft source:
Savings
Visa
other:
(if no designation, savings is the default)
Sub Savings # Special title:
(if no special title, the default is Special Savings account)
Certificate Account # Opening amount:

Designate:
Compound Dividends
OR
Transfer dividends to Star One account number
(if no designation, the default is compound dividends)
Additional Services
Touchtone Teller Access
ATM/Visa Debit Card (checking required for debit card)
Online Banking
Bill Pay
Automatic debit from Star One account

Joint Owner or Custodian Information

Joint Owner Information for Joint Accounts (held jointly with right of survivorship) or Custodian Information for Transfers to Minors Accounts

Joint Owner/UTMA Custodian Name:
SSN/TIN:
U.S. ID Type:
ID Number:
ID Issuing State:
ID Issue Date:
ID Exp. Date:
Birth Date:
Residential Address (no P.O. boxes):
Residential Address, line 2:
City/State/Zip:
Mailing Address:
City/State/Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:
Employer:
Password Identifier:
Occupation:
Joint Owner/UTMA Custodian Name:
SSN/TIN:
U.S. ID Type:
ID Number:
ID Issuing State:
ID Issue Date:
ID Exp. Date:
Birth Date:
Residential Address (no P.O. boxes):
Residential Address, line 2:
City/State/Zip:
Mailing Address:
City/State/Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:
Employer:
Password Identifier:
Occupation:
Joint Owner/UTMA Custodian Name:
SSN/TIN:
U.S. ID Type:
ID Number:
ID Issuing State:
ID Issue Date:
ID Exp. Date:
Birth Date:
Residential Address (no P.O. boxes):
Residential Address, line 2:
City/State/Zip:
Mailing Address:
City/State/Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:
Employer:
Password Identifier:
Occupation:

Designate Pay-on-Death Beneficiaries

Beneficiary information is not required; however, failure to provide such information may disqualify the account from additional NCUSIF share insurance available for multiple beneficiary accounts.

Beneficiary Name:
Residential Address (no P.O. boxes):
City/State/Zip:
Mailing Address:
City/State/Zip:
SSN/TIN:
Birth Date:
Relationship to Member:
Beneficiary Name:
Residential Address (no P.O. boxes):
City/State/Zip:
Mailing Address:
City/State/Zip:
SSN/TIN:
Birth Date:
Relationship to Member:
Beneficiary Name:
Residential Address (no P.O. boxes):
City/State/Zip:
Mailing Address:
City/State/Zip:
SSN/TIN:
Birth Date:
Relationship to Member:
Beneficiary Name:
Residential Address (no P.O. boxes):
City/State/Zip:
Mailing Address:
City/State/Zip:
SSN/TIN:
Birth Date:
Relationship to Member:

Designate UTMA Successor Custodian

Successor Custodian Name:
SSN/TIN:
Residential Address (no P.O. boxes)
E-mail Address:
City/State/Zip:
Phone:
Work Phone:
Cell Phone:

TIN Certification and Backup Withholding Information

By signing this document, I certify, under penalties of perjury, that (1) I am a U.S. person (including a U.S. resident alien), (2) the Social Security number (SSN)/taxpayer identification number (TIN) shown is my/the correct identification number and (3) I am NOT, unless designated below, subject to backup withholding because I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding. Check below applicable boxes:

I am subject to backup withholding
I am exempt
I am NOT a United States citizen or U.S. person (complete W-8BEN form)

Acknowledgements

Consent to Utilize Credit Report for Additional Services:

Occasionally, Star One Credit Union uses information obtained from an applicant's credit report to evaluate if additional products or services will enhance the financial well-being of the applicant. To enable Star One to provide this valuable service, we have added this disclosure to request your authorization to used information in your credit report to make future credit offers.

For Account and/or Account Service Requests: by signing below, you acknowledge that you have received and agree to the terms and conditions contained in the Membership and Account Agreement, Truth in Savings Disclosure, Funds Availability Policy Disclosure, Electronic Funds Transfer Agreement and Disclosure and Privacy Notice and to any amendments to these documents that the Credit Union may make from time to time.

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

This Membership Application and Account Card must be signed by all account owners. If updates are being made, this will supersede the current Membership Application and Account Card on file.


___________________________________________
Signature		 _______________________
Date
___________________________________________
Signature		 _______________________
Date

Trust account details

Name of Trust
Date of Trust
Social Security Number / TIN
Trustor Name
Trustor Name
Trustee Name
Trustee Name
Successor Trustee(s)
Residential Address (no P.O. Boxes)
Residential Address Line 2
City / State / Zip
Phone Number Home
Phone Number Work

___________________________________________
Trustee Signature		 _______________________
Date
___________________________________________
Trustee Signature		 _______________________
Date
___________________________________________
Trustor Signature		 _______________________
Date
___________________________________________
Trustor Signature		 _______________________
Date
Star One Credit Union use only
Opened by (Operator ID & initials):
Date:

Rev: 03/19/2014