TexStar Federal Credit Union - Secure Membership Application

Membership Application

Membership Eligibility

First Name

Middle Initial

Last Name

Date of Birth

Marital Status

Email Address

Phone Type

Phone Number

Driver's License #

DL State of Issue

SSN

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.

Mother's Maiden Name

Present Address

Street Address

City

State

Zip Code

Is there a joint applicant?

No Yes

Joint Applicant Information

First Name

Middle Initial

Last Name

Date of Birth

Marital Status

Email Address

Phone Type

Phone Number

Driver's License #

DL State of Issue

SSN

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.

Mother's Maiden Name

Beneficiaries

Full Name

Home Address

Relationship

Phone #

Full Name

Home Address

Relationship

Phone #

Full Name

Home Address

Relationship

Phone #

TIN CERTIFICATION AND BACKUP WITHHOLDING INFORMATION

Under penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number,
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding Click here to cross out
I am a U.S. person (including a U.S. resident alien).

Certification Instructions. Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Cross out item 3 and complete a W-8 BEN if you are not a U.S. person.

AUTHORIZATION

I/we agree to the terms and conditions of the Membership and Account Agreement,Truth-in-Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We have received and read the Agreement and Disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree tot the terms of and acknowledge receipt of the Electronic Funds Transfer Agreement.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.