Business Membership Application

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Business or Organization Information

Name of Business or Organization*

Address*

Street Address City State ZIP Code

Phone*

Additional Phone

Email*

Taxpayer ID Number

Type of Business/Organization*

Number of Owners*

Service(s)

I'm interested in opening the following:

Business checking account

Business money market account

Business share certificate

Business loan

Authorization*

I authorize Members Exchange to pull my consumer credit report.

Representative(s) Information

(A representative may start, conduct transactions, change, add and terminate an account, product or service for the business or organization.)

Representative

Name	Title	Address	Home Phone	Mobile Phone	SSN	Drivers License Number	Date of Birth	Email	Employer/Retired From	Occupation/Profession	Work Phone	Role	Actions

There are no Representatives.

Owner*

First Last

Title

Owner Date of Birth*

Owner SSN*

Owner Address

Street Address City State ZIP Code

Unexpired Gov Issued ID (Driver's License)

Overdraft Protection

Yes

I understand that my account will be charged an overdraft transfer fee for each overdraft transfer made.

Certification of Owner(s)

Persons opening an account on behalf of a Legal Entity must provide the following information.

a. Name and Title of Natural Person opening account

Name*

First Last

Title*

b. Name and Address of Legal Entity for which the account is being opened:

Name of Legal Entity*

Address of Legal Entity*

Street Address Mailing Address City State ZIP Code

c. The following information for each individual*, if any, who directly or indirectly, through any contract, arrangement, understanding, relationship, or otherwise, owns 25% or more of the entity.

Owners

Name	Date of Birth	Address	For U.S. Persons: Social Security #	% of Ownership	Actions

There are no Owners.

d. The following information for one individual with significant responsibility for managing the Legal Entity listed above, such as:

An executive officer or senior manager (e.g. Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, Treasurer); or
Any other individual who regularly performs similar functions. If appropriate, an individual listed under section (c) above may also be listed in this section (d).

Control

Name	Date of Birth	Address	For U.S. Persons: Social Security #	% of Ownership	Actions

There are no Entries.

Agreement

I hereby certify to the best of my knowledge, that the information provided above is complete and correct. I also agree to contact Members Exchange Credit Union in the event that any of this information changes in the future.*

First Last

Date*

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