Joint Share Account Agreement Form (Page 2 of 2) in pdf

INSTRUCTION TO SIGNER: If you have been notified by the Internal Revenue Service (IRS) that you are

subject to backup withholding due to payee underreporting and you have not received a notice from the

IRS that the backup withholding has terminated, you must strike out the language in clause 2 of

whichever certification you sign below:

CERTIFICATION AS TO TAXPAYER IDENTIFICATION NUMBER AND BACK UP WITHHOLDING

Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer

identification number and (2) that I am not subject to backup withholding either because I have not

been notified that I am subject to back up 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 not longer subject to backup

withholding.

I understand that if I do not provide a taxpayer identification number to the credit union within 60 days,

the credit union is required to withhold 20% (20 percent) of all reportable payments thereafter made to

me until I provide a number.

SIGNATURE: ____________________________________________________ DATE: _________________

MONROEVILLE BORO FEDERAL CREDIT UNION PAYROLL DEDUCTION AUTHORIZATION / CHANGE

EMPLOYEE NAME ______________________________________

ACCOUNT ____________

EMPLOYEE # ______________

SOCIAL SECURITY # ____________________________________

TO PAYMASTER: I hereby authorize you to deduct the following amount from my pay:

$_____________ each pay until further notice from me and transmit same currently to the above

named CREDIT UNION.

Write in amount: $ _________ Regular Shares $__________ Christmas Club Effective Date: ________

EMPLOYE SIGNATURE: ________________________________________ DATE SIGNED ____/_____/___

*If allocating your deduction to multiple accounts complete the following:

The amount in the sections below must match the total above

Write in amount for both REGULAR SHARES and CHRISTMAS CLUB

Member Name _________________________________ Reg Sh Amt: $_________ Xmas: $_______

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Joint Share Account Agreement Form Page 2