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What are you applying for?

Tell us about yourself!

First Name*	Middle Name

Last Name*	Suffix

Date of Birth*	SSN*

Email*	Phone*
	-
Contact Method*

Street Address*	Extra Address (apt# etc)

City*	State*

Zipcode*	Mailing Address*

Mail Street*	Mail City*

Mail State*	Mail Zipcode*

Employer*	Occupation *i

Mother's Maiden*	ID Type*

Issuing State*	ID Number*

ID Issue Date*	ID Expiration Date*

I agree that Park may contact me for (among other purposes) promotions and information on my account using direct dial, prerecorded messages, automatic dialers or through the use of text messages. I have the right to withdraw my consent at any time. Please click here for full description.
I am a U.S. Citizen

Add a co-applicant?

co-applicant

First Name*	Middle Name

Last Name*	Suffix

Date of Birth*	SSN*

Email*	Phone*
	-
Contact Method

Street Address*	Extra Address

City*	State*

Zipcode*	Employer*

Occupation*	Mother's Maiden*

ID Type*	Issuing State*

ID Number*	ID Issue Date*

ID Expiration Date*

I agree that Park may contact me for (among other purposes) promotions and information on my account using direct dial, prerecorded messages, automatic dialers or through the use of text messages. I have the right to withdraw my consent at any time. Please click here for full description.

I am a U.S. Citizen

Branch Region

Promo Code

I would like to add:

Savings Checking Certificate

Have you, or a close family member, been a politically exposed person?i	Yes	No
Do you travel outside the US?	Yes	No

	Certification of Taxpayer Identification Number and Backup Withholdings
	Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number, 2. I am not subject to backup withholdings 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 withholdings as a result of failure to report all interest or dividends or c) the IRS has notified me that I am no longer subject to backup withholding, and 3.
	Authorization By signing or otherwise authenticating
	I/we agree to the terms and conditions of the Membership and Account Agreement, Disclosure Packet and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge electronic receipt of the agreements and disclosures applicable to the accounts and services requested herein. I/We also agree to maintain a minimum balance of $5.00 in a share account to continue membership with Park Community CU. Please click here for full description.
	USA Patriot Act To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account or creates a new member relationship.

Certificate

Which share to fund the certificate from?

What amount would you like to open the certificate with?

I have a joint on my account that I would like to add to the certificate