Application and Member Information

Account No. _______________________________________________________
Member Name _____________________________________________________
Street ___________________________________________________________
City/State/Zip ____________________________________________________________
Home Phone ___________________________ Work Phone _______________________
SSN/TIN ______________________________  Date of Birth ______________________
Mother's Maiden Name ___________________ Driver's Lic. No ____________________
Employer ______________________________ Position/Title ______________________
                   Years ________  Full Time        Part Time Hrs. ________________
Income:  Gross    Monthly $ _________________ (or)  Net Monthly $ ____________
Home:  Own     Rent How long? ______ Years Monthly Payment $ ______________

Joint Owner _____________________________________________________________
Street __________________________________________________________________
City/State/Zip ____________________________________________________________
Home Phone ___________________________ Work Phone _______________________
SSN/TIN ______________________________  Date of Birth ______________________
Mother's Maiden Name ___________________ Driver's Lic. No ____________________
Employer ______________________________ Position/Title ______________________
                   Years ________  Full Time        Part Time Hrs. ________________
Income:  Gross    Monthly $ _________________ (or)  Net Monthly $ ____________
Home:  Own     Rent How long? ______ Years Monthly Payment $ ______________

  I/We request the following services (please mark):

ATM Card
     Overdraft Protection/Line of Credit
Debit Card
     Audio Response     Home Banking     Bill Payment
By checking the boxes above and signing below, you certify that the information on this application is complete, true, and submitted for the purpose of obtaining the electronic service(s) and account(s) requested. You agree: (a) that the Credit Union can use credit reporting agencies or otherwise verify the information on this Application for the purpose of extending credit or services to you or reviewing or collecting on a loan account of yours; (b) that the Credit Union can tell others about its credit experience with you and obtain information from others about your credit history and performance. If you request, the Credit Union will tell you the name and address of any credit reporting agency from which it received a credit report on you. If approved for the requested electronic funds transfer services, you acknowledge receipt of and agree to the terms of the Electronic Funds Transfer Agreement.

  ________________________________________________________________
Member's Signature                                                     Date

_______________________________________________________________
Joint Owner                                                                  Date  

Please detach and return APPLICATION to the Fort Stewart Georgia Federal Credit Union
* After you mail or fax Please call the credit union to confirm receipt. We are not responsible for request that do not reach us.