Application for Creighton Federal Membership
General Information
First Name:*
M.I.:
Last:*
Permanent Street Address:*
City:*
St:*
Zip:*
Phone Number:*
(0000000000)
Date of Birth:*
(MMDDYYYY)
SSN:
(000000000)
Present Employer:
Employer's Phone:
DL Number:
DL State:
Email Address:*
Gender
Male
Female
Joint Owner Information
First Name:
M.I.:
Last:
Street:
City:
St:
Zip:
Phone Number:
(0000000000)
Date of Birth:
(MMDDYYYY)
Social Security Number:
(000000000)
DL Number:
DL State:
Email Address:
Ownership of Account
Single Party Account
With Pay-on-Death Beneficiary
Without Pay-on-Death Beneficiary
Multiple Party Account
With Right of Survivorship
With Right of Survivorship and Pay-on-Death Beneficiary
Minor Account
Pay-on-Death Beneficiary:
New Account Information
Account Type (Check all that apply):
Savings (Required)
Checking
Money Market
CD
Member eligibility requires a $5.00 deposit to a savings account
CFCU Member Qualification
Please state how you qualify for membership at Creighton Federal Credit Union:
Creighton University
Alegent Health
Other:
Online Banking / Electronic Bill Payer
To sign up for Creighton Federal's FREE Online Banking, please fill out the information below:
Yes, I would like Online Banking Services
* To sign up for Crieghton Federal's FREE online banking, please go to
https://www.creightonfederal.org
and complete the Online Banking Enrollment
Yes, I would like Electronic Bill Payer*
* To sign-up, enroll in Online Banking. * Electronic Bill Payer is free as long as bill pay activity occurs every 90 days. Otherwise, a $5.00 monhtly service charge will apply.
ATM / Debit Card
Yes, I would like an ATM Card
- or -
Yes, I would like an ATM / Debit Card
(Requires Checking)
Requires seperate application
Backup Withholding Certifications
Please check those that apply:
Taxpayer I.D. Number
- The Taxpayer Identification Number shown on this page is my correct Taxpayer Identification Number.
Backup Withholding
- I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding.
Exempt Recipients
- I am an exempt recipient under the Internal Revenue Service Regulations.
Nonresident Aliens
- I am not a United States person, or if I am an individual, I am neither a citizen nor a resident of the United States.
If you are not a US citizen
, please provide your passport ID number:
Disclosures
I have recieved the following information from the credit union:
Disclosure Pamphlet
Privacy Statement
Fee Schedule
Credit Union Office
Please select the credit union branch for this account:
Main Office
Student Center
Northwest
Bergan
Mercy Hospital
Additional Information
Please use this space for any additional information or comments: