Atlanta Teachers Federal Credit Union

Forms & Applications

MEMBER APPLICATION

MEMBER INFORMATION

Name _________________________________________________________________________________________

Address/City/State/Zip__________________________________________________________________________

SSN/TIN ______________________________________

Phone________________________________

Date of Birth ______________________

Driver's Lic. # ___________________

MMN_________________

Present Employer(name & address)______________________________________________________________

__________________________________________________________

Phone_______________________

I qualify for membership in this Credit Union because_____________________________________________

Name and address of someone who will always know your location _________________________________

_______________________________________________________________________________________________

JOINT OWNERS/MINOR INFORMATION

Name _________________________________________________________________________________________

Address/City/State/Zip__________________________________________________________________________

SSN/TIN ______________________________________

Phone________________________________

Date of Birth ______________________

Driver's Lic. # ___________________

MMN__________________

Name _________________________________________________________________________________________

Address/City/State/Zip__________________________________________________________________________

SSN/TIN ______________________________________

Phone________________________________

Date of Birth ______________________

Driver's Lic. # ___________________

MMN__________________

OWNERSHIP OF ACCOUNT

SELECT ONE OWNERSHIP TYPE AND, IF APPLICABLE, INCLUDE A BENEFICIARY DESIGNATION. THE OWNERSHIP TYPE AND BENEFICIARY DESIGNATION SPECIFIED ON THIS DOCUMENT WILL REMAIN THE SAME FOR ALL ACCOUNTS LISTED BELOW.

INDIVIDUAL

JOINT WITH SURVIVORSHIP (and not as tenants in common)

MEMBER AS CUSTODIAN FOR MINOR UNDER THE GEORGIA TRANSFERS TO MINORS ACT (GTMA)

TRUST - SEPARATE AGREEMENT DATED ____________________________________________________

________________________________________________________________________________________

BENEFICIARIES:	REVOCABLE TRUST OR	PAY-ON-DEATH DESIGNATION AS
DEFINED IN THE ACCOUNT TERMS AND CONDITIONS: (Place name and address of beneficiaries below.)
___________________________________________		___________________________________________
___________________________________________		___________________________________________

ACCOUNT TYPE

___________________________________________

Number of signatures required for withdrawal ________.

This is a temporary account agreement.

SIGNATURES & CERTIFICATIONS

BACKUP WITHHOLDING CERTIFICATION - Check box (A) only if true or (B) below:

(A)	By signing below, I (name) _____________________________________________________________

certify under penalties of perjury that (1) the Taxpayer Identification Number (TIN) shown above is my correct TIN and I am not subject to bakcup withholding either because (a) I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends or (b) the IRS has notified me that I am no longer subject to backup withholding.

(B)	A separate Certification has been completed.

By signing below, the undersigned agree to the Credit Union by-laws and the terms and conditions of any approved account, as ammended from time to time, and authorize the Credit Union to verify credit and employment history by any necessary means, including preparation of a credit report by a credit reporting agency. The undersigned certify that the information provided on this application is true and correct and that the terms on this application apply to all listed accounts. The undersigned acknowledg receipt of a copy of the terms and conditions applicable to each listed account and the following policy disclosures:

Funds Availability

Truth-In-Savings

Electronic Fund Transfers

__________________

THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATIONS REQUIRED TO AVOID BACKUP WITHHOLDING.

(2) X

_______________________________________ Member Signature

_____________________
(Date)

______________________
Member/Account #

(2) X

_______________________________________ Signature

_____________________
(Date)

______________________
Relationship to Member

(3) X

_______________________________________ Signature

_____________________
(Date)

______________________
Relationship to Member