Application For Membership and Proxy
Primary: SS#: BDate:
Joint 1: SS#: BDate
Joint 2: SS#: BDate
Address: Home Phone#
City, State, Zip: Work Phone#
By signing below, I make application for membership in and agree to conform to the bylaws, disclosures, and any amendments thereof in the Illinois Community Credit Union. I authorize the Credit Union to check my credit history. I also agree to the terms and conditions of any account that I have in the Credit Union now or in the future and agree that the Credit Union may change those terms and conditions from time to time.
Taxpayer Identification and Backup Withholding Certification
Under penalties of perjury, I certify (1) that the number shown in this form is my correct taxpayer identification number and (2) that I am not subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service (IRS) has notified me that I am no longer subject to backup withholding. (NOTE: If you have been notified by the Internal Revenue Service that you are subject to backup withholding and you have not received notification from the Internal Revenue Service that backup withholding has been terminated, you must strike-out clause (2) above.
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Primary Member's Signature Date
Proxy
The member does herby constitute and appoint the members of the Board of Directors of the Credit Union, who are qualified and acting directors at the time this proxy is used, as proxies to cast all voted to which the member is entitled, for the election of directors, mergers and any matter with regard to which Credit Union shareholders are entitled to vote by proxy, as the said directors or a majority of them see fit, at all annual or special meetings of the members of said credit union hereafter and any adjournment thereof, from time to time and year to year, until and unless this proxy is cancelled by the member. The member further authorized the said proxies to designate a person or committee to cast the vote or votes of the member in such a manner and for such candidates at the said proxy shall determine, herby ratifying whatever the said proxies may do in the premises.
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Primary Member's Signature Date
Joint Share Account Agreement
Non-Transferable*
The Illinois Community Credit Union is hereby authorized to recognize any of the signatures subscribed below in the payment of funds or the transaction of any business for this account. The joint owners of this account hereby agree with each other and with said credit union that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said joint owners to their credit as such joint owners with all accumulations thereon ,are and shall be owned by them jointly, with right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor or survivors shall be valid and discharge said credit union form any liability for such payment. The joint owners also agree to the terms and conditions of the account as established by the Credit Union from time to time. Any or all of said joint owners may pledge all of any part of the shares in this account as collateral security to a loan or loans from the Credit Union. The right or authority of the Credit Union under this agreement shall no be charged or terminated by said owners, or any of them except by written notice to said credit union which shall no affect transactions theretofore made. *as defined in 12 DFR Part 204
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Signature, Joint Member 1 Date
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Signature, Joint Member 2 Date Credit Union official accepting application Date
