Hoosier Hills Credit Union - Membership Card

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Membership Card

Eligibility Information

You are eligible to become a member of Hoosier Hills Credit Union, if you live or work in one of the following counties:
Bartholomew, Clark, Crawford, Daviess, Dearborn, Dubois, Floyd, Green, Harrison, Jackson, Jefferson, Lawrence, Martin, Monroe, Orange, Perry, Spencer, or Washington; OR if you work at one of the listed places of employment.

Click here for the list.
Type your membership eligiblity below.

TIN Certification and Backup Withholding Information

By signing below, I certify under penalties of perjury, that the Social Security Number (SSN) or Taxpayer Identification Number (TIN) shown on the Membership Application is my/the correct identification number and that I am NOT, unless designated below, subject to backup withholding because I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding.

I am subject to backup withholding.
Exempt
I am not a United States citizen or resident (complete W-8 form)

Signature______________________________________ Date________________

Account Designations

Payable on Death (POD) Trust Account
All Accounts
Designate specific account(s)

Beneficiary
Address

UTTMA / UGMA (as custodian for (minor) under the Uniform Transfers / Gifts to Minors Act). Minor's TIN

Agency --- Name of Agent
All Accounts Designate specific accounts

Joint Share Account Agreement
*NOT TRANSFERABLE Hoosier Hills 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 account. This agreement also authorizes Hoosier Hills Credit Union to check the account, credit and employment history, and obtain a credit report from third parties including credit reporting agencies to verify eligibility for the accounts and services requested. The joint owners of this account hereby agree with each other and with said Credit Union that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any and 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 survirorship 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 from any liability for such payment. The joint owners also agree to the terms and conditions of the account as established by the Credit Union from time to time. Any or all of said joint owners may pledge all or any part of the shares in this 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 said Credit Union which shall not affect transactions made prior to the receipt of the said written notice by the Credit Union. I/We authorize you to check my/our credit and employment history and to answer questions from others about your credit experience with me/us. By signing below, I/We agree to the terms and conditions of the membership and account agreement as stated above, the Truth-in-Savings rate and fee schedule, the Funds Availability policy disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I/We acknowledge viewing and/or printing a copy of the agreement and disclosures applicable to the accounts and services requested herein.
Date_____________
SSN or TIN	Joint Owners (each must sign below)
_____________________	__________________________________
_____________________	__________________________________
_____________________	__________________________________

For Credit Union Use Only
Approved by Membership Officer Board Exec. Committee	Signed ___________________________ Date__________________

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