Secure Membership Form

Complete the following On-Line Membership Request Form (below) and submit it.
Once submitted please email a copy of your driver's license to fcu@fasnycu.com
Once we have received your request to join and your drivers license we will send you a membership application/signature card to be electronically signed.
Once you have signed and submitted the application please mail a minimum check of $5 to the credit union for your opening deposit at which time the account will then be opened.

Submitted On:

Membership Eligibility:

How did you hear about us?

Personal Information

First Name

Middle Initial

Last Name

Street Address

City

State

Zip Code

Date of Birth (mm/dd/yyyy)

Phone #:

Email Address:

Social Security #:

This is a secure application but if you are uncomfortable providing your SSN here you may call us with this info after submission. We cannot process your application without this information.

Driver's License #*

DL State of Issue*

Mothers Maiden Name*

Employer*

Employer Phone number*

Occupation*

Interested in:

Savings

Checking

Christmas Club

Vacation Club

Tax Saver Club

Certification as to Taxpayer Identification Number & Backup Withholding
Under penalties of perjury, I certify (1 ) that the number shown on this form is my correct taxpayer identification number (S.S. #) and (2) that I am not subject to backup withholding either because I have not been notified that I'm subject to backup withholding as a result of or failure to report all interest or dividends, or the Internal Revenue Services (IRS) has notified me that I am no longer subject to backup
withholding.

The Membership/Signature card you will sign includes the following statements and agreements:

I hereby make application for membership in FASNY Federal Credit Union, and agree to conform to its bylaws and amendments thereof, and to subscribe for at least one (1) share. The FASNY Federal Credit Union is hereby authorized to recognize any of the signatures subscribed hereto 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 conditions of the account as established by the Credit Union from time to time. Any or all of said joint owners may pledge all or any part of the shares in this account as collateral security to a loan or loans from this Credit Union. The right, or authority of the Credit Union under this agreement shall not be changed or terminated by said owners, or any of them, except by written notice to said Credit Union which shall not affect transactions theretofore made.

Under the 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 has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including a U.S. resident alien).

Protecting Children's Online Privacy:
We do not knowingly collect, nor is our Home Banking site designed or directed, to use personal information from children under the age of 13 without containing verifiable consent from their parents. Should a child whom we know to be under the age of 13 send personal information to us, we will only use that information to respond directly to that child, seek parental consent or provide parental notice.