- Complete the following On-Line Membership Application Request Form and submit it.
- Once received, we will mail to you a pre-filled application form requiring your signature and the signature(s) of your joint owner(s) (if applicable).
- The signed Membership application must be returned to the credit union along with an initial deposit of at least $25.00 and / or direct deposit form, and a copy of a government issued photo ID for you and any other joint owners for the application process to be completed.
The Membership/Signature card you will sign includes
the following statements and agreements:
I hereby make application for membership in Healthcare Services Credit Union, and agree to conform to
its bylaws and amendments thereof, and to subscribe for at least
one (1) share. The Healthcare Services CU 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 Healthcare Services CU
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 Healthcare Services CU 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 Healthcare Services CU under this agreement shall not be
changed or terminated by said owners, or any of them, except
by written notice to Healthcare Services CU which shall not affect transactions
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. citizen
(including a U.S. resident alien).