MEMBERSHIP APPLICATION Corning Federal Credit Union One Credit Union Plaza Corning, NY 14830-1050 INSTRUCTIONS: Complete the form, online if preferred. Print the application. Have your signature notarized. Mail the form to the attention of Member Contact Services or drop off at one of our Credit Union offices. Please include the appropriate deposit(s).   Prior to applying for membership: Click here to verify your eligibility for membership. Please click here and review our Member Services Guide (disclosures) Please click here and review our Fee Schedule All new Accounts are verified through ChexSystems (a nationwide verification network), other identity verification networks, and our internal verification procedures. To add a Joint Member to an existing Membership, click here. MEMBER INFORMATION First Name M.I. Last Name Social Security Number Date of Birth (mm/dd/yyyy) Residence Address: Residence Address(2): City:    State:    Zip: Mailing Address (if different): Home Phone: ( )        Work/Daytime Phone: ( )   Ext: Your Email Address: Your Mother's Maiden Name: Drivers License #: State: Issue Date: Expiration Date: Government ID#: Type: Country: Issue Date: Exp. Date: *Government issued ID is only necessary if no Driver's license # is provided Are you retired?   Yes   No   Please indicate your Field of Membership by clicking on one of the Field of Membership options below, then completing the requested information. I or someone I am related to works for Corning Incorporated or its subsidiaries. I work for Corning Incorporated         Employee # I am related to an employee of Corning Incorporated         Employee Name         Relationship to You I am related to a current Corning Credit Union member. I am related a current Corning Credit Union member         Member Name         Relationship to You I or someone I am related to works for Corning Credit Union. I work for Corning Corning Credit Union         Employee # I am related to an employee of Corning Credit Union         Employee Name         Relationship to You I belong to a Member Group served by Corning Credit Union. I belong to a Member Group served by Corning Credit Union (click here for a complete listing)         Member Group I live, work, worship, or attend school in a Community served by Corning Credit Union. I live, work, worship, or attend school in a Community served by Corning Credit Union (click here for a complete listing)         Community: Select one... Chemung County Area, NY City of Wilmington, NC Mon Valley Area, PA State College, PA Waynesboro, PA I am a current member of Corning Credit Union. I am a current member of Corning Credit Union         Member Account Number     JOINT MEMBERS Click here to add Joint Member 1 Information Joint Member/Owner 1 Information First Name M.I. Last Name Social Security Number Date of Birth (mm/dd/yyyy) Drivers License #: State: Issue Date: Expiration Date: Government ID#: Type: Country: Issue Date: Exp. Date: *Government issued ID is only necessary if no Driver's license # is provided Please indicate Field of Membership for Joint Member 1 by clicking on one of the Field of Membership options below, then completing the requested information. I or someone I am related to works for Corning Incorporated or its subsidiaries. I work for Corning Incorporated         Employee # I am related to an employee of Corning Incorporated         Employee Name         Relationship to You I am related to a current Corning Credit Union member. I am related a current Corning Credit Union member         Member Name         Relationship to You I or someone I am related to works for Corning Credit Union. I work for Corning Corning Credit Union         Employee # I am related to an employee of Corning Credit Union         Employee Name         Relationship to You I belong to a Member Group served by Corning Credit Union. I belong to a Member Group served by Corning Credit Union (click here for a complete listing)         Member Group I live, work, worship, or attend school in a Community served by Corning Credit Union. I live, work, worship, or attend school in a Community served by Corning Credit Union (click here for a complete listing)         Community: Select one... Chemung County Area, NY City of Wilmington, NC Mon Valley Area, PA State College, PA Waynesboro, PA I am a current member of Corning Credit Union. I am a current member of Corning Credit Union         Member Account Number I will be added as a Joint Owner. I will be added as a Joint Owner Click here to add Joint Member 2 Information Joint Member/Owner 2 Information First Name M.I. Last Name Social Security Number Date of Birth (mm/dd/yyyy) Drivers License #: State: Issue Date: Expiration Date: Government ID#: Type: Country: Issue Date: Exp. Date: *Government issued ID is only necessary if no Driver's license # is provided Please indicate Field of Membership for Joint Member 2 by clicking on one of the Field of Membership options below, then completing the requested information. I or someone I am related to works for Corning Incorporated or its subsidiaries. I work for Corning Incorporated         Employee # I am related to an employee of Corning Incorporated         Employee Name         Relationship to You I am related to a current Corning Credit Union member. I am related a current Corning Credit Union member         Member Name         Relationship to You I or someone I am related to works for Corning Credit Union. I work for Corning Corning Credit Union         Employee # I am related to an employee of Corning Credit Union         Employee Name         Relationship to You I belong to a Member Group served by Corning Credit Union. I belong to a Member Group served by Corning Credit Union (click here for a complete listing)         Member Group I live, work, worship, or attend school in a Community served by Corning Credit Union. I live, work, worship, or attend school in a Community served by Corning Credit Union (click here for a complete listing)         Community: Select one... Chemung County Area, NY City of Wilmington, NC Mon Valley Area, PA State College, PA Waynesboro, PA I am a current member of Corning Credit Union. I am a current member of Corning Credit Union         Member Account Number I will be added as a Joint Owner. I will be added as a Joint Owner Click here to add Joint Member 3 Information Joint Member/Owner 3 Information First Name M.I. Last Name Social Security Number Date of Birth (mm/dd/yyyy) Drivers License #: State: Issue Date: Expiration Date: Government ID#: Type: Country: Issue Date: Exp. Date: *Government issued ID is only necessary if no Driver's license # is provided Please indicate Field of Membership for Joint Member 3 by clicking on one of the Field of Membership options below, then completing the requested information. I or someone I am related to works for Corning Incorporated or its subsidiaries. I work for Corning Incorporated         Employee # I am related to an employee of Corning Incorporated         Employee Name         Relationship to You I am related to a current Corning Credit Union member. I am related a current Corning Credit Union member         Member Name         Relationship to You I or someone I am related to works for Corning Credit Union. I work for Corning Corning Credit Union         Employee # I am related to an employee of Corning Credit Union         Employee Name         Relationship to You I belong to a Member Group served by Corning Credit Union. I belong to a Member Group served by Corning Credit Union (click here for a complete listing)         Member Group I live, work, worship, or attend school in a Community served by Corning Credit Union. I live, work, worship, or attend school in a Community served by Corning Credit Union (click here for a complete listing)         Community: Select one... Chemung County Area, NY City of Wilmington, NC Mon Valley Area, PA State College, PA Waynesboro, PA I am a current member of Corning Credit Union. I am a current member of Corning Credit Union         Member Account Number I will be added as a Joint Owner. I will be added as a Joint Owner ACCOUNTS / SERVICES Please indicate your initial deposit amount $ $5.00 minimum balance required. You must open a Prime Share Savings Account to establish your membership. In addition to opening the Prime Share Savings Account, I request to add the following Accounts: Please click the account(s) that you would like to add and provide the requested information. Holiday Club Yes, please add a Holiday Club.         Initial deposit amount $ ($0.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. All Purpose Savings Yes, please add an All Purpose Savings Account.         Initial deposit amount $ ($0.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. Money Market Account Yes, please add a Money Market Account.         Initial deposit amount $ ($2500.00 minimum balance required to earn dividends) Windfall Checking Account Yes, please add a Windfall Checking Account. You must be age 18 or have a Joint Member/Owner on the account that is at least 18 and willing to sign this application to authorize the account. Certain services are required to open this account.         Initial deposit amount $ ($0.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. Value Share Draft Checking Account Yes, please add a Value Share Draft Checking Account. You must be age 18 or have a Joint Member/Owner on the account that is at least 18 and willing to sign this application to authorize the account.         Initial deposit amount $ ($0.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. Advantage Share Draft Checking Account Yes, please add an Advantage Share Draft Checking Account. You must be age 18 or have a Joint Member/Owner on the account that is at least 18 and willing to sign this application to authorize the account.         Initial deposit amount $ ($4000.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. Minor Windfall Checking Account Yes, please add a Minor Windfall Checking Account. Only available to members age 13-17. An adult in good standing must be joint on the account. Certain services are required to open this account.         Initial deposit amount $ ($0.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. X-treme Checking Account Yes, please add an X-treme Checking Account. Only available to members age 13-17. An adult in good standing must be joint on the account.         Initial deposit amount $ ($0.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. Travel & Expense Checking Account Yes, please add a Travel & Expense Checking Account. You must be age 18 or have a Joint Member/Owner on the account that is at least 18 and willing to sign this application to authorize the account.         Initial deposit amount $ ($0.00 minimum balance required)         Account Title If you are using this account for a specific reason, you may assign an account title. I request to add the following Services: Please click the service(s) that you would like to add and provide the requested information. CU-Extra Check Card To apply for a CU-Extra Check Card, you must be age 18, or you may be 17 years of age or older and have an adult on the account as a joint owner.   Prime Member 4 digit PIN Card Title*   Joint Member 1 4 digit PIN Card Title*   Joint Member 2 4 digit PIN Card Title*   Joint Member 3 4 digit PIN Card Title*   *If you are using this account for a specific reason, you may assign a card title to help you remember which card accesses this account. You may select the same P.I.N. for ALL SERVICES. For security reasons, do not use numbers such as 1111, 1234, your social security number, phone number, date of birth, or any combination thereof. X-treme Check Card Available to members in good standing, age 13-17. An adult in good standing must be joint on the account.   Prime Member 4 digit PIN Card Title*   Joint Member 1 4 digit PIN Card Title*   Joint Member 2 4 digit PIN Card Title*   Joint Member 3 4 digit PIN Card Title*   *If you are using this account for a specific reason, you may assign a card title to help you remember which card accesses this account. M.O.M. (ATM) Card If you are opening a Checking Account, please order a CU-Extra Check Card instead of a M.O.M. Card. Minors must have an adult (age 18 or over) on their Account willing to sign to authorize a M.O.M. Card   Prime Member 4 digit PIN Card Title*   Joint Member 1 4 digit PIN Card Title*   Joint Member 2 4 digit PIN Card Title*   Joint Member 3 4 digit PIN Card Title*   *If you are using this account for a specific reason, you may assign a card title to help you remember which card accesses this account. You may select the same P.I.N. for ALL SERVICES. For security reasons, do not use numbers such as 1111, 1234, your social security number, phone number, date of birth, or any combination thereof. D.A.D. (Dial Accounts Direct) Telephone Access Used to transfer between Accounts/Loans under this Member Account Number.   D.A.D.       4-Digit Access Code (only one access code can be assigned per Member Account Number Cross Member D.A.D. Used to transfer between this Member Account Number and other Member Account Numbers in which you are Prime or Joint.   D.A.D.       4-Digit Access Code (only one access code can be assigned per Member Account Number Indicate Member Account Numbers for Cross Member D.A.D. FROM this Member Account Number... To: Check if you would like to transfer from the Member Account Number entered TO this Membership To: Check if you would like to transfer from the Member Account Number entered TO this Membership To: Check if you would like to transfer from the Member Account Number entered TO this Membership To: Check if you would like to transfer from the Member Account Number entered TO this Membership To: Check if you would like to transfer from the Member Account Number entered TO this Membership Home Banking (Internet Account Access) Our Home Banking service puts a wealth of information right at your fintertips! Access your accounts, transfer funds, make loan payments, add subaccounts and services. All 24 hours a day, 7 days a week. Once your application for Membership is processed, please visit our website and click on the Home Banking Login link to enroll for the Home Banking, Bill Pay, and eStatement services. All Accounts are variable rate Accounts. As such, the Credit Union reserves the right to change the rates at any time and at its sole discretion. AGREEMENT TO TERMS/JOINT ACCOUNT INFORMATION Each person signing applies for membership in Corning Federal Credit Union. The accounts I (we) open at, and the services I (we) receive from the Credit Union will be governed by the provisions of this application, the Member Services Guide and the Credit Union Bylaws, as amended from time to time. I (we) agree to the terms and conditions as stated in those documents. If more than one person signs below, each person signing understands that each account will be governed by the "Joint Accounts" section of the Member Services Guide. All subaccounts as "joint tenants with right of survivorship" regardless of whose funds are deposited in the account and regardless of who deposits the funds in the account. Any person on the account acting alone can open a joint subaccount and request credit union services in the names of all owners of the account. Any one of us acting alone shall have the right to draw on the accounts, without limit, and may pledge all or part of the shares in our joint share accounts and subaccounts as collateral security for a loan or loans from the Corning Credit Union. In the case of the death of either or any of us, the survivor or survivors shall be the sole owner or owners of the entire account subject to any applicable legal claims on the decedent's share of the funds. The Credit Union may and shall send all notices and account statements only to the Prime Member's address. If these are joint accounts/services with a minor, I (we) adult joint members(s) understand that the accounts/services are governed by the "Notice to Adults Opening Adult/Minor Joint Accounts/Services" section of the Member Services Guide and I (we) agree to the terms and conditions stated. Each person signing below instructs any and all credit reporting agencies to provide a copy of his or her credit report to the Corning Credit Union at any time the Credit Union requests such a report. Certification as to Taxpayer Identification Number and Backup Withholding Instruction to the Prime Member: If you have been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding due to payee underreporting and you have not received a notice from the IRS that the backup withholding has been terminated, you must strike out the language in clause 2 below. Certification as to Taxpayer Identification Number and Backup Withholding: Under penalties of perjury, I certify that (1) the number shown on this form is my correct taxpayer identification number, and (2) I am not subject to backup withholding either because (a) I am exempt from backup withholding, or (b) I have not been notified by the 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, and (3) I am a U.S. person (including a US resident alien). IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING AN ACCOUNT: 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. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask you to provide your driver's license or other identifying documents. If we determine that you have supplied false or misleading information on this application, this application will be deemed void. The information you supplied on this application will be used to verify that you are in our field of membership. If we cannot verify that you are in our field of membership, we will be unable to establish a permanent account for you, even if we have already established a preliminary account for you. THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN CERTIFICATIONS REQUIRED TO AVOID BACKUP WITHHOLDING. Signatures must be Notarized or Witnessed by a Credit Union Employee Member Signature ______________________________________________________     Date _______________ Joint Member 1 Signature ________________________________________________     (if applicable) Date _______________ Joint Member 2 Signature ________________________________________________     (if applicable) Date _______________ Joint Member 3 Signature ________________________________________________     (if applicable) Date _______________ Places that may have a Notary: Post Office, Public Library, Police Station, Social Security Office, Colleges, Universities, County Clerk Offices, City, State & Federal Office Buildings. Prime Member: Notary Acknowledgment STATE OF _______________________ COUNTY OF __________________________ On the ______ day of _________________________ (month/year), before me personally appeared _______________________________ (Name of signer), or proved to me on the basis of satisfactory evidence to be the individuals described in and who executed the above instrument, and he/she/they duly acknowledged to me that he/she/they executed the same. ___________________________________ Commission Expires _____________________ Notary Name                       Embossed/Inked Seal Joint Member 1: Notary Acknowledgment STATE OF _______________________ COUNTY OF __________________________ On the ______ day of _________________________ (month/year), before me personally appeared _______________________________ (Name of signer), or proved to me on the basis of satisfactory evidence to be the individuals described in and who executed the above instrument, and he/she/they duly acknowledged to me that he/she/they executed the same. ___________________________________ Commission Expires _____________________ Notary Name                       Embossed/Inked Seal Joint Member 2: Notary Acknowledgment STATE OF _______________________ COUNTY OF __________________________ On the ______ day of _________________________ (month/year), before me personally appeared _______________________________ (Name of signer), or proved to me on the basis of satisfactory evidence to be the individuals described in and who executed the above instrument, and he/she/they duly acknowledged to me that he/she/they executed the same. ___________________________________ Commission Expires _____________________ Notary Name                       Embossed/Inked Seal Joint Member 3: Notary Acknowledgment STATE OF _______________________ COUNTY OF __________________________ On the ______ day of _________________________ (month/year), before me personally appeared _______________________________ (Name of signer), or proved to me on the basis of satisfactory evidence to be the individuals described in and who executed the above instrument, and he/she/they duly acknowledged to me that he/she/they executed the same. ___________________________________ Commission Expires _____________________ Notary Name                       Embossed/Inked Seal For Credit Union Use Only Member Account Number Assigned:_____________________ ChexSystems called: _________________________ Date:  ________ Dtec performed by: _________________________ Date:  ________ Field of Membership verified by: _________________________ Date:  ________ Home Phone verified by: _________________________ Date:  ________ Work Phone verified by: _________________________ Date:  ________ Entered by: _________________________ Date:  ________ Approved by: _________________________ Date:  ________ State any discrepency in the identity information provided above that was discovered through the identity verification process, and state the resolution of the discrepancy. _____________________________________________________________________________________ _____________________________________________________________________________________ Please be advised that all checks are subject to funds verification. ** You are automatically enrolled for Basic Overdraw Protection when you open a Checking Account. Transfers will be made from this Share Savings Account (if funds are available) to cover checks that would cause an insufficient balance. In addition, you are automatically enrolled for our Enhanced Overdraw Protection Program. If you wish to discontinue the Enhanced Overdraw Protection Program, please contact the Credit Union and we will discontinue Enhanced Overdraw Protection within 5 business days of receipt of your request.  We also offer convenient overdraw protection options utilizing the Corning Credit Union Visa Card. Once we have processed your Membership application, you may apply for your Visa online using our online loan application. In order to expedite your request, please remember to: Make checks payable to Corning CU. Include at least a $5.00 Savings Account deposit to open your Membership. Include the appropriate minimum balance required for the Money Market and/or Advantage Share Draft Checking Accounts. Sign this application in the presence of a Notary or Corning Credit Union employee. What's Next? A Member Service Representative will contact you within one business day to confirm receipt of your application and to see if there is anything we can help you with regarding your new CCU membership A Member Welcome Kit will be mailed to you.