C&O United Credit Union Membership Application

To become a member of the C&O United Credit Union fill out the membership application, print it,
sign on the signature line(s), and mail to:

C&O United Credit Union
3029 Dixie Highway
Edgewood, KY  41017-2362

In order to comply with the USA Patriot Act, you must include a copy of your current driver's license
with your application to open an account.

Membership Number _________________________________
(to be completed by credit union staff)

TYPE OF ACCOUNT
                                    Individual Account
                                    Joint Account
                                    To Make Joint

Primary Member (1) [first, last]
SSN (1)
Employer (1)
DOB (1)
Home Address
City State Zip
Home Phone Work Phone

Joint Owner (2)
SSN (2)
Employer (2)
DOB (2)
Home Address
City State Zip
Home Phone Work Phone

Joint Owner (3)
SSN (3)

Membership Eligibility

Company Name
Family Member of
Relationship

Please check accounts/services which you wish to open/use:

Share (savings) Account
Funds Manager
Overdraft Protection
Christmas Club
Special

ATM card(s)
Vacation Club
Checking
Payroll Deduction

CREDIT UNION USE ONLY
Draft Account Number _________________ TIS Disclosure ________
ATM Application _______
Type of ID _________________ ID # ____________________
This application is approved by __________________
on ______
20 ___

I (We) agree to terms and requirements which I (we) have received on the above accounts/services and agree that the Credit Union may change those terms and requirements from time to time. TAXPAYER IDENTIFICATION CERTIFICATE AND BACKUP WITHHOLDING - I (primarily member) certify under penalties of perjury that (a) the number shown on the front of this form is the correct taxpayer identification number and (b) I am not subject to backup withhoding as a failure to report all interest or dividends, or the Internal Revenue Service (IRS) has notified me that I am no longer subject to backup withholding. If you are subject to backup withholding due to failure to report all interest or dividends, cross out section (b). JOINT ACCOUTS ONLY - The Credit Union is hereby authorized to recognize any of the signatures subscribed below in the payment of funds or the transaction of any business for this (these) account(s). The joint owners of this account hereby agree with each other and with said credit union that all sums now paid in on all shares, or heretofore or hereafter paid in on all 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 credit union form any liability for such payment. Any or all of said joint owners may pledge all or any part of the shares in this regular share (savings) account as collateral security to a loan or loans from the 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 the Credit Union which shall not affect transactions theretofore made. INITIAL DEPOSIT - Please find enclosed a check for at least $5. I understand this will be deposited on my primary share account to maintain my membership. "The Internal Revenue Services does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding."

X________________________
Primary Members Signature

XX_______________________
Joint Owner's Signature

________
DATE