Individual Membership or Account Opening - BrightView Federal Credit Union

Account Type(Required)

Savings (Required)

Checking

Please select each account that you wish to open.

I will pay the $5.00 initial deposit for the savings through:(Required)

Online using my debit card

Bringing cash to a Brightview branch

A $5.00 initial deposit is required before the savings can be opened. No deposit is required for the checking. If the deposit is being paid online, a representative will reach out to you to take the deposit over the phone.

Primary Member's Name(Required)

First Middle Last Suffix

Date of Birth(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Employer / Main Source of Income(Required)

Start Date

Monthly Gross Income

Primary Member's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number(Required)

Driver's License / Identification Number(Required)

State Issued(Required)

Expiration Date(Required)

Photo Identification Upload(Required)

Max. file size: 64 MB.

Must be a government issued form of identification with a clear photo. Reproductions not accepted.

Additional Identification Upload(Required)

Max. file size: 64 MB.

Secondary Government Identification, Social Security Card, Birth Certificate, Credit Card (Not Debit)

Payable Upon Death's Name(Required)

First Last

The Payable Upon Death (POD) will be the beneficiary of any account selected above.

Payable Upon Death's Date of Birth(Required)

Payable Upon Death's Social Security Number(Required)

Additional Services

Electronic Statements

Automatic Deposits from another Financial Institution

Debit Card (Only for Checking)

Overdraft Protection (Only for Checking) - Transfer to checking if available in savings (Fee per transaction)

Courtesy Pay (Only for Checking) - If no funds are available, overdraw account to cover transactions (Fee per transaction)

If an additional service is unchecked, we will opt you out of that service. You will have to reach out to the credit union to reactivate that service in the future.

CAPTCHA

TIN Certification and Backup Withholding Information(Required)

Under Penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued), and I am not subject to backup withholding 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 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 I am a U.S. citizen or other U.S. person. For federal tax purposes, you are considered a U.S. person if you are: an individual who is a U.S. citizen or U.S. resident alien; a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; an estate (other than a foreign estate); or a domestic trust (as defined in Regulations section 301.7701-7). The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Complete a W-8 BEN if yor are not a U.S. person. If a W-8 BEN is completed, your signature does not serve to certify this section.

Authorization(Required)

I agree to the following statement:

By signing below, I/we agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, 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 receipt of a copy of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I/we agree to the terms of and acknowledge receipt of the Electronic Fund Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Additional Information Required Authorization(Required)

I agree to the following statement:

I understand that a $5.00 initial deposit is required for the membership to be opened. This deposit can be made online by going to www.brightviewcu.com, and clicking "Make a Payment". It can also be brought into any Brightview Credit Union branch. A savings account is required before a checking account can be opened. All account owners on a checking must pass a ChexSystems/Qualifile check and owe no charged off balances to other financial institutions. Additional required forms will be sent for esignature. All additional forms must be signed via esign or in person before the membership is valid.

Primary Account Holder's Printed Name(Required)

First Last

By entering your name here, you agree to the statement in the TIN Certification and Backup Withholding Information section and the Authorization section.

Today's Date(Required)

Name

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

Individual Ownership Membership or Account Form

Company

Important Disclosures

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