Form 202 - Ups Employees Application Form printable pdf download

UPS Employees

ADDITIONAL SERVICES REQUEST

Federal Credit Union

CHANGE REQUEST

3110-A Inland Empire Blvd., Ontario, CA 91764-6572

(909) 481-2805 / (866) 987-7668

TYPE OF CHANGE _____________________________

Member Name (Print)_______________________________________________________________________________ Account No.___________________________________

I hereby make application for the account(s) indicated below and agree that the account(s) is/are subject to the terms of the Membership Invitation/Signature Card. I understand and agree that the account(s)

indicated below are owned by any joint owner(s) set forth on the Membership Invitation/Signature Card. To help the 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 who opens a account. What this means for me: when I open an account, you will ask for my name,

address, date of birth, and other information that will allow you to identify me. You may also ask to see my driver’s license or other identifying documents.

$_____________

Checking Account

: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

($50.00 minimum deposit required)

Transfer from:

Savings

Check Enclosed . . . . . . . . . . . . . .

to account approval)

(You must complete Section 2 below - subject

VISA Debit Card

*SEE REVERSE FOR PIN SELECTION

(VISA DEBIT CARD ONLY)

Other__________________________________________________________________________________________________________________________________

SECTION 2 ADDING JOINT OWNER

If you did not originally have a joint owner and you wish to add a Joint Owner to all your account(s) please complete the information below.

Both the primary member and new joint owner must sign at bottom.

___________________________________________________________ _______________________________ ____________________________________

Joint Owner Name

Driver’s License No.

Mothers Maiden Name

___________________________________________________________

(________)________________________ (________)_______________________

Home Address

City

State

Zip

Home Phone

Work Phone

___________________________ _______________________________ ____________________________________________________________________

Date of Birth

Social Security No.

Internet Address

__________________________________________________ _______________________________________________ $___________________________

Employer

Occupation

Monthly Salary

SECTION 3 ADDING A BENEFICIARY

If you, as the primary member, would like to add a beneficiary, please complete the information below and sign where indicated.

BENEFICIARY(IES) in the event of my death, or if there is more than one owner of this account, in the event of death of all the owners, the owner(s)

hereby designate as my/our beneficiary(ies) to receive all sums in my/our account(s) as indicated below.

____________________________________________________________________ (_________)_________________________ _____________________

Name

Phone No.

New Phone

Percent of Account

____________________________________________________________________ ___________________________________ _____________________

Address

City

State

Zip

Social Security No.

Date of Birth

____________________________________________________________________ (_________)_________________________ _____________________

Name

Phone No.

New Phone

Percent of Account

____________________________________________________________________ ___________________________________ _____________________

Address

City

State

Zip

Social Security No.

Date of Birth

SECTION 4 AUTHORIZATIONS & SIGNATURES

In this Additional Services/Change Request Form “I” and “My” mean each and every person who signs below. “You” and “Your” mean UPS Employees Federal Credit Union. I understand I

will be given access to TLC (your audio response system). By signing below, I agree to conform to your bylaws as well as all applicable terms and conditions set forth in the Deposit Account

Agreement, Truth in Savings Disclosure, the Certificate Account Agreement and Disclosure (if applicable), and Electronic Services Disclosure and Agreement (receipt of all of which is hereby

acknowledged and which is incorporated by this reference). I understand and agree that this Additional Services/Change Request Form shall govern the Regular Share, the Checking Account,

the ATM/VISA Debit Card and the TLC Audio Response Service and other accounts designated above. I authorize you to open other account(s) for me in person or via mail.

By signing below, I also authorize you to gather credit, checking account and employment information you consider appropriate from time to time thereafter. I understand that this will assist,

for example, in determining my initial and ongoing eligibility for an account and for making future credit opportunities available to me. I authorize you to give information concerning your

experience with me to others. I understand and agree that you may retain this Additional Services/Change Request Form and any other information you may receive and that I waive my

right to confidentiality of my records with the Department of Motor Vehicles and authorize you to obtain such information form the DMV.

X_____________________________________________ _______________ X_____________________________________________ ______________

Primary Members Signature

Date

New Joint Owner Signature (If Applicable)

Date

00133-1907

CREDIT UNION USE ONLY

FORM 202 REV. 1/15